PHYSICAL FITNESS OF ADULTS WITH AN INTELLECTUAL DISABILITY: A 13 YEAR FOLLOW-UP STUDY

ANDWW J. GRAHAM

DEPARTMENT OF PHYSICAL EDUCATION McGiil University Montreal, Canada.

A thesis submitted to the Faculty of Graduate Studies and Research

in partial fullilment of the requirements of the degree of Master of Arts

0 Andrew J. Graham, 1996

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The purpose of this study was to describe the physical fitness of midde-aged

adults with an intellectual disability and how their state of fitness has changed over tirne.

Thirty-two adults with an inteiiectuaf disability served as participants: 14 were female and

18 were male. Participants had an age range &om 34 to 57 years. AU worked at a

readaptation center in Montreal and were participants in a study of physical fitness in

1983. Using the "Canadian Standardized Test of Fitness", the participants were evaluated

on tests of Cardiovascular Endurance, Muscular Strength, Muscular Endurance, Flexibil-

ity, and Body Composition. All participants were deemed physically capable of perform-

ing al1 the tests after a screening procedure was used. A home visit, previous to the

testing session, familiarized the participants with the procedures for each test. The baitery

of tests took one hour per participant. Three levels of analysis were used to descnbe the

change in physical fitness with age: Fust, the conversion of raw scores into percentiles

highlighted individual dzerences within the group. Second, to assess the change in fitness

over tirne, a 2x2 (group x tirne) repeated measures design was used. Third, effect sues

were calculated to measure the magnitude of change in fitness over the 13 year period as

compared to the general population. Results indicate that, when compared to the general

population, the participants had lower levels of fitness and that their fitness had changed

significantly over tirne. Most interesting were resuits showing that the participants had a

significantly greater magnitude of change in VOZmax and percent body fat than what is

expected in the general population. The findings of this study raise concerns regarding the

potential health risks associated with aging and poor fitness for adults with an intellectual

disability.

Le but de cette etude etait de decrire la condition physique d'adulte d'âge moyen

ayant une déficience intellectuelle, et aussi comment I'etat de leur condition a change au

cours du temps. Trente-deux adultes comportant une déficience intellectuelle ont servi en

tant que participants: 14 femmes et 18 hommes. Leur âge respectif variait de 34 a 57 ans.

Tous travaillaient dans un centre de réadaptation a Montreai et participant a une etude sur

la condition physique en 1983. A l'aide du "Canadian Standardized Test of litness", les

participants ont été evalue sur leur endurance cardiovasculaire, leur force musculaire, leur

endurance musculaire, leur flexibilite, et leur composition corporelle. Tous les participants

etaient juges capable d'accomplir tous les tests après qu'une procédure de depistage soit a

utilisee. Des visites a la maison, effectue& avant la session d'dvaiuation, ont familiarise

les participants aux differents procédures de chaque tests. La batterie de test a pris une

heure par participant. Trois niveaux d'analyse ont été utilise pour décrire le changement

de la condition physique avec l'âge. Prernierèment, la conversion des resultats bruts en

pourcentages a mis en valeur les différences individuelles au sien du groupe.

Deuxièmement, afin d'estimer le changement de condition physique au fil du temps, un

concept de mesures repetCes (2x2, group x temps) a été utilise. Troisiemement, les

effects-granduer ont et6 calculés pour mesurer la magnitude de changement de la condi-

tion physique pendant la periode de 13 ans telle que comparée à la population en generale.

Les résultats indiquent que, cornparés à la population en gènéral, les participants avaient

un niveau de condition physique moins èléve et que celle-ci avait changé de facon

signifiante au fil du temps. Un fait intéressant fit celui des résultats demontrant que les

participants avaient une magnitude de changement en V02max et du pourcentage de

tissus adipeux corporel beaucoup plus élevé que ce qui est prevu dans la population en

gènèral. Les constatations de cette étude soulèvent quelques inquiétudes au sujet de

risques potentiels à la santé associés au vieillissement et a une pauvre forme physique

d'adultes ayant une dèficience intellectuelle.

iii

ACKNOWLEDGEMENTS

This project would not be complete without recognking and thanking those who

played such an invaluable role in supporting me throughout this MA thesis.

1 extend my deepest appreciation and thanks to Dr. Greg Reid for having confi-

dence in rny ability and encouraging me to do the hard work in complethg this project.

Greg, thank you for giving me the guidance, expertise, and time needed for rny educa-

tional development. Many thanks are given to Dr. Helene Perrault and Dr. Graham Neil

for agreeing to be members of my colioquium cornmittee. Your advice and suggestions

are greatly appreciated. To Tom Carson of McGill, whose patience is greatly appreciated

(you know what 1 rnean, Tom).

To my good fkiend and colleague, Bill Harvey, whose enthusiasm and commitrnent

to our profession have always been a source of inspiration to me. Thanks for ail the help

and encouragement buddy.

1 would like to extend my deepest gratitude to the participants in this shidy. Your

generosiiy and willingness wiii always be remembered.

Thanks go to Jack Carlon and Steve Duckett of West Island Readaptation Center

for taking time out from their busy schedules to help make this project succeed. To my

unselfish fiend and former colleague, Ken Francis, who gave so willingly of his time to

assist in the data collection, thank you. Thank you to rny colleague and hend Isabelle

Larouche for the translation of my abstract.

1 would like to induectly thank my Elementary School Physical Education Teacher,

~ r s . . Woznitza, who, through her excitement and creativity when teaching, first inspired

me to value and appreciate al1 that physical activity has to offer.

Most important, I am deeply indebted to my wife, Tara, and my daughter, Kristin.

Thank you both for supporting me during al1 the ups and downs. Thank you for giving me

the time away from you that 1 needed to finish my thesis. Nothing is more important to

me than you both. I love you.

TABLE OF CONTENTS (cootinued)

Chapter 4 Page

4.1 Reliability ......................................................................... 4.2 Analysis of Anthropometric Results ................................

4.2.1 Height ................................................................. 4.2.2 Weight .................... .... ...............................

.................................................. 4.2.3 BodyMassIndex 4.2.4 Percent Body Fat ................ ... ........................

4.3 Muscular Endurance and Strength .................................... ........................... 4.3.1 Grip Strength ............... ....

4.3.2 Push-ups ..............................................................

4.5 Cardiovascular Endurance ...............................................

Chapter 5

Discussion ................

5.1 Anthropometric Measmes ................................................... 5.1.1 Height .................................................................. 5.1.2 Weight .................................................................

................................................. 5.1.3 BodyMassindex 5.1.4 Percent Body Fat .................................................

5.2 Muscular Endurance ........................................................ 5.3 Flexibility ........................................................................... 5.4 Cardiovascular Endurance .................................................. 5.5 Change in Physical Fitness-Hypothesis 1.3.1 .................. 5.6 Magnitude of Change in Physicd Fitness

Hypothesis 1 .3.2 ............................................................

Chapter 6

Summary. Condusioas. and Recommendations ................. 80

6.1 Summary of the Methodology ........................................ 80 6 -2 Surnmary of the Findings ................................................. 81 6.3 Conclusions ..................................................................... 82

TABLE OF CONTENTS (continued)

. . 6 -4 Implications ..................................................................... 6.5 Recommendations for Further Investigation .....................

REFERENCES ..

APPENDICES . A.

APPENDIX A:

APPENDIX B:

APPENDIX C:

APPENDIX D:

APPENDIX E:

APPENDK G:

APPENDIX H:

APPENDIX 1:

APPENDIX J:

ANTHROPOMETRIC PROCEDURES ..................

STRENGTH PROCEDURES .................................

MUSCULAR E N D W C E PROCEDURES .......

FLEXIB ILITY PROCEDURES ............................

HEART RATE AND BLOOD PRESSURE .................................................... PROCEDURES

CARDIOVASCULAR ENDURANCE ................................................... PROCEDURES

DATA COLLECTION FORMS ..............................

DESCRIPTION OF STUDY AND CONSENT .................................................................. FORMS

REVXSED PHYSICAL ACTMTY READINESS ................................................ QLESTIONNPJRE

MCGILL ETHICS COMMlTTEE APPROVAL .....

vii

LIST OF TABLES

Ta b te

............... Evidence of the Benefits of Physical Activity on Health

Reasons for Subject not Participating in the Study .........................

................ Omnibus Test of Significance on 9 Dependent Variables

Anthropometric Individual Results ..............................................

.... Repeated Measures ANOVA and Descnptive Results for Height

........................................... Comparison of Effect Sizes for Height

Repeated Measures ANOVA and Descnptive Results for Weight ..

........................................ Cornparison of Effect Sizes for Weight

Repeated Measures ANOVA and Descriptive Results for Body Mass Index .....................................................................

Cornparison of Effect Sizes for Body Mass Index ..........................

Repeated Measures ANOVA and Descriptive Results for Percent Body Fat ......................................................................

........................... Comparison of Effect Sizes for Percent Body Fat

Repeated Measures ANOVA and Descriptive Results for Grip Strength ............................................................................

Muscular Endurance. Muscular S trength, and Flexibility: Individual Results .........................................................

Repeated Measures ANOVA and Descnptive Results for Push.ups ...................................................................................

............................ ......... Cornparison of Effect Sizes for Push-ups ...

Page

16

32

39

42

48

49

50

5 t

52

53

54

55

57

58

63

63

viii I

LIST OF TABLES (continued) Page

1 7 Repeated Measures ANOVA and Descriptive Results for Sit-ups ...................................................................................... 65

18 Compatison of Effect Sizes for Push-ups ........................................ 65

19 Repeated Measures ANOVA and Descnptive Results . . - for Flextbility ................................................................................... 66

20 Cardiovascular Endurance: individual Resuits.. ................................ 68

2 1 Repeated Measures ANOVA and Descriptive Results for Cardiovascular Endurance.. ........................................................ 69

22 Cornparison of EEect Sizes for VMmax. ......................................... 70

Chapter 1

Introduction

There is growing recognition arnong health professionals that Mestyle choices

contribute a great deal to the quaiity of one's Me (McAdey & Rudolph, 1995;

PaCfenbarger, 1990). Lifestyle choices such as participation in physical activity, eating

habits (Wood, 1993), and smoking have been linked to mortality (Seccareccia & Menotti,

1 Wî), the prevention of disease (Jette, Sidney, Quemeville, & Landry, 1

psychological well-being (McAuley & Rudolph, 1995), and the state of personal physical

fitness (Blair, 1995). Making positive Mestyle choices a2pears to contnbute to overall

health in a beneficial manner.

Lately, health-related physicai fitness, in the rniddle age of one's Me, has become a

major concem. Several studies have demonstrated that a significant decline in fitness

occurs throughout middle age (Gohg, Williams, Lohman, & Hewitt, 1994; Lee,

PafFenbarger, & Hsieh, 1992; Paenbarger, Karnpert, Lee, Hyde, Leung, & Wing, 1994).

The-decline in fitness during the middle age years has been positively correlated with a

decrease in the amount of physical activity one engages in during this same period. In

fact, some reports show an inverse relationship between the amount of physical activity

and the incidence of cornrnon chronic diseases such as some forms of cancer and diabetes

mellitus (Raurarnrna, Tuornainen, Vaisanen, & Rankinen, 1995). Estimations suggest that

if half the population of sedentary individuals in the United States would become even

moderately active, the number of deaths occumng f?om coronary heart disease, colon

cancer, and diabetes would f d by 22,000 per year (Blair, 1995). More dramatic estimates

would be expected if more individuals would becorne moderately to highly active.

Empirically-based research has yet to detennine how the interaction of each variable

mentioned above contributes to the decline of fitness throughout one's life. Regardless,

evidence exists that the adoption of an active lifestyle can increase one's level of physical

fitness and may have a positive influence on one's health. As a result, iifestyle choices

associated with physical activity have become an important and meaningful area of inquiry.

1

In 198 1, the most extensive and comprehensive study of fitness and physical

activity patterns was undertaken in Canada (Government of Canada, 1982). The survey t

tested approximately 16,000 Canadians ranging in age kom 7 to 69 years. More

specifically, the survey evaluated the physical fitness components of body composition,

cardiovascular endurance, muscular strength, muscular endurance, and flexibility. From

the age of 20 onwards, a clear decline in performance was observed in ail five components

as age increased. With the exception of muscular strength, this decline appeared to

accelerate notably in the early middle age years (age 35).

Cardiovascular endurance is considered to be the most prominent component of

fitness as "it reflects the efficiency of the heart and lungs in moving energy-iaden oxygen

from the air to the muscles that need it" (Government of Canada, 1982, p. 10).

Cardiovascular efficiency is fundamental in aliowing individuals to sustain any activity

during work or play. As well, authors recognize that cardiovascular h d t h risks associated

with inactivity and poor fitness may have a role to play in the acquisition of coronary heart

disease, elevated cholesterol, stroke, and hypertension (Bokovoy & Blair, 1994; Powell & I

Blair, 1994). The "Canada Fitness Survey" showed that cardiovascular fitness continued

to fall steadily throughout the age span. On the "Canada Home Fitness Test" (CHFT)

(Government of Canada, 198 l), a majority of the population reached a recomrnended level

of cardiovascular fitness or 85% of their maximum workload. One-third reached a minimal

level or 70% of their maximum workload, and about 5% of those tested performed at an

unacceptable level or a workload at 70% of maximum for someone 10 years older.

Interestingly, the proportion of individuals screened out of the testing, due to exercise

related health risks, remained very consistent and did not substantiaiiy increase until the

age group of 45 to 64. Despite the fact that the majority of subjects reaciier 85% of their

maximum workload, the older subjects did not fare as well. Only 7% of t he 65 to 69 year

old participants reached 85% of their predicted maximum workload. Those screened out

of the testing were broadiy considered unfit. As with cardiovascular fitness, the flexibility t

of participants began declining in the earliest years continuing throughout the age span

with a marked decline after the age of 24. The component of muscular endurance was

aiso undoubtedly related to age with peak performances observed around 14 to 15 years

of age with a steady decline afterwards. In cornparison, the muscular strength of partici-

pants peaked between 20-39 years of age and deciined slightly throughout the years.

Participants in the survey showed a gradua1 accumulation of body fat until the age of 50-

59.

It is evident from the results of The Canada Fitness Survey that a decline of fitness

occurs throughout one's lifetime and is pronounced during the middle age years especidy

for the component of cardiovascular fitness. Yet, the decline in fitness is Likely related to

decreased participation in physical activity.

The relationship between physical fitness and physical activity throughout the

middle age years has been studied by Seccareccia and Menotti (1992) and Sandvik,

Enkssen, Mundal, and Rodhd (1 993). In a 25-year follow-up study of 1720 middle-aged

Italian men, Seccareccia and Menotti (1 992) showed that those who remained active

throughout the 25 years were less likely to die of coronary heart disease. In their 16-year

foilow-up study of 1960 apparently healthy men, Sandvik et al. (1993) detennined that the

difference between resting heart rate and exercise induced heart rate was a consistent

predictor of cardiovascular mortality. Those with low resting heart rates had a decreased

risk of dying prematurely £?om cardiovascular heart disease and interestingly, tended to

participate in more physicaily demanding work activities. The results fiom these studies

imply positive benefits 60m increased participation in physicai activities.

Most of the population have the ability and the opponunity to attend to their own

health. As a result, most public and private campaigns (i.e., YMCA, Participaction)

designed to educate and encourage society towards leading a healthy and active lifestyle,

are geared to those who have the cornpetence to be able to use and benefit from these

campaigns. The question of fieedom of choice and preference are some major factors

which challenge able-bodied citizens to pursue an active lifestyle. However, there are

groups of people who require assistance in seizing opportunities to live a healthy and

active lifestyle. One such group, representing roughly between 1% (Arnencan

Psychological Association, 1992) and 3% (Sherrill, 1994) of the population, is persons

with an intellectual disability. It is questionable whether persons with an inteîiectual

disability are aware of the debilitating consequences of a sedentary lifestyle. Even if they

were made aware through education, it is debatable whether they would have enough self-

direction to modifL their lifestyle (Pitetti, Rimmer, & Fernhaii, 1993).

It is well founded that persons with an intellectual disability exhibit poor fitness

performance on standard fitness tests (Beasley, 1 982; Coleman, Ayoub, Friedrich, 1 976;

Fernhall, 1993; Pitetti, Jackson, Stubbs, Campbell, & Battar, 1989; Reid, Montgomery, &

Seidl, 1985). In fact, some studies report that persons with an intellectual disability

involved with physical activity, may perform poorly on fitness tests in cornparison to

sedentary non-disabled persons (Pitetti et al., 1989; Reid et ai., 1985). These poor levels

of physical fitness have been attributed to variables such as poor motor control (Moon &

Rezaglia, l982), a sedentary lifestyle (Burkart, Fox, & Rotaton, l985), institutionalized

living (Pitetti et al, 1 993), and genetic factors as with some persons with Down's syn-

drome (Block, 199 1). There is speculation that the rate of decline in physical capabilities

of persons with an intellectuai disability is faster than that of the generai population (Pitetti

& Campbell, 199 1). In fact, persons with an intellectual disability have an established

lower limit for the onset of old age as well as a higher mortality rate (Pitetti & Campbell,

199 1).

Maintaining an adequate arnount of physicai fitness is especially crucial throughout

one's lifetirne and especially throughout ones adulthood. With the thnist towards

de-institutionalization, persons with intellectual disabilities face challenges in ail aspects of

cornmunity life (Pedlar, 1990). Many facets of cornmunity life, such as work, maintainhg

a household, cooking, selfcare, and recreation require the individual to possess a certain

amount of physical starnina. Persons with an inteilectuai disability will require an adequate

amount of fitness to contribute in a society that values excellence, not only to complete

work tasks, but also to enjoy and benefit fkom participation in recreational activities

(Fenihall, Tymeson, & Webster, 1983).

The decline of fitness during middle age, although well established for the non-

handicapped population, has not been given much attention for persons with an intellectual

disability. Of course, participation in physical activity leading to improvements in general

health would be a viable goal for persons with an intellectml disability, however, the

rese.arch in this area is "scattered, incomplete and hampered with poor research designs"

(Fernhall et ai., 1983, p.24). Studies concerning the physical fitness of persons with an

intellectual disability (Pitetti et al., 1993) have examined physical fitness performance, vali-

dation of fitness testing procedures, training, exercise prograrnrning, and body composi-

tion. Although these studies provide invaluable information about the fitness of persons

with an intellectual disability, an insufficient m o u d of data-based research exists isolating

the variable of aging and its role on the physical health of this population. Conclusions

have been made citing a number of potential factors explaining the low fitness levels of

persons with an inteilectual disability, including sedentary living, environmental and

genetic influences, that they are subject to a higher mortality rate and early onset of

cardiovascular disease. Research on the interaction of these factors has been based on

evidence that is both inconclusive and obscure. Hence, the need to expand the database in

the area of aging and fitness for persons with an inteiiectual disabiiity is long overdue.

1.1 Significance of the Study

Large epidemiological studies have s h o w that persons need an adequate level of

fitness to live healthy, disease fiee lives (Blair, Kohl, Barlow, PatTenbarger, Gibbons, &

Macera, 1 995; Lee, Hsieh, & Psenbarger, 1995; Paffenbarger, et al., 1994). The benefits

to be gained fiom an active lifestyle are numerous and may result in a reduction of the

following health risks: coronary heart disease, osteoporosis, depression, hypertension,

rend disease, type 11 diabetes, some forms of cancer, depression, anxiety, etc. (Shephard.

1995). As previously mentioned, it is weii documented that persons with an inteliectuai

disability exhibit substandard physical fitness when compared with the non-handicapped

population. Considering the added effects of obesity (Fox & Rotatori, 1982), it is Iikely

that certain health risks associated with a substandard level of fitness would become an

even greater issue for these people. It would therefore, be appropriate to provide

opportunities for perçons with an intellectual disability to become involved in physical

activities, while concurrently working toward having them assume responsibility for their

own health. Foresight and planning are sMls that the health professional must possess in

order to efficiently and intelligently plan for physicai activity and fitness programming.

With the few existing exercise training programs designed for the specific needs of persons

with an intellectual disability, health professionak are left with Little to work with. Once

info.imation describing the physical fitness characteristics of persons with an inteilectuai

disability is obtained effective physical fitness prograrnrning can be administered (Sheph-

ard, 1991).

Even though the research comrnunity has estabiished a lower levei of fitness

characterized by persons with an inteliectual disability, no data appears exists revealing

how their fitness has changed over time. In the Harvard Alumni Health studies,

Pdenbarger, Hyde, Wing, Lee, Jung, and Karnpert (1993) have done extensive longitudi-

nal work recording the physical activity patterns of thousands of individu&. They have

established a link between participation in physical activity and ail-cause mortality. The a

rniddle age has also been shown to be the period in one's Me when some components of

fitness begin to steadily decline (Government of Canada, 198 1). Assuming that the decline

in fitness among persons with an inteliectuai disability foiiows the same pattern as those

persons without disabilities compounded with an already well documented lower level of

physical fitness, this population would be expected to experience dficulty in sustaining

the energy needed to perforrn even the simplest of daiiy activities. The implications for

personai health would aiso have to be given consideration. Research on aging and fitness

may also veriQ some of the data which descnbes the higher rate of mortality and early

onset of old age in persons with an intellectual disabiiity. It is yet to be determined what

magnitude of difference exists between the decline in fitness for non-handicapped persons

and the decline of fitness for persons with an intellectual disability.

Accordingly, the significance of an investigation of the physical fitness characteris-

tics of persons with an inteiiectual disability as they age, is to expand a knowledge base 1

that contains little information regarding the role of aging, physical activity, fitness, and

health of persons with an intellectual disability.

1.2 Statement of the Problem

The purpose of this study is to descnbe the physical fitness of middle-aged adults

with an intellectual disability and how their state of fitness has changed over t h e .

Hypotheses

As a group, the present fitness of persons with an inteliectual disability will

be significantly lower than their state of fitness recorded in 1983.

The magnitude of dEerence in fitness for the group of adults with an

intellectuai disability between the present study and the 1953 study will be

significantly greater than the magnitude of difference in the noms estab-

lished for the non-handicapped population.

Delimitations

The following delimitations will be considered in this study:

Al1 participants had participated in a study in 1983.

Ail participants are middle-aged adults with an inteilectual disability be-

tween 34 and 57 years of age.

Al1 protocols for testing in this study were replicated from the study in

1983.

Limitations

The following limitations will be considered in this study:

Factors potentially influencing the physicai fitness of adults (i.e., fatigue,

anxiety, motivation, etc.) were not measured. Effort was made before and

during the testing to reduce the influence of any potential negative factors

that could have confounded the results. Participants have known the

testers for at least four yean. In addition, testing equipment and proce-

dures were fully descnbed to each participant. During testing, verbal

encouragement and reassurance was given to heip the participant feel at

ease.

Measurement of physical fitness did not take into consideration the causes

of declining physicai fitness. The question posed in this midy is to describe

the changes in physical fitness of adults with an inteiiecnial disability.

Ident-g causes for declining physical fitness may make valuable materiai

for funher investigation.

1.6 Definitions

Persons with an Intellectuai disabiiity: Refers to a sigruficantly subaverage generd

intellectual functioning (an IQ of approxhmtely 70 or below) with onset before the age 18

years and concurrent deficits or impairments in adaptive fùnctioning (Amencan Psycho-

iogicai Association, 1994).

Physicd Fitness: Health related physicai fitness is the term most widely acceptai

(Eichstaedt & Lavay, 1992) and will be defined by the foliowing components to be

measured in this snidy: cardiovascuiar endurance, muscular endurance, muscular strength,

flexibility, and percent body fat.

Cardiovascular endurance: Degree to which one can perform repetitions of stress

requinng the use of the circulatory and respiratory system. This WU assessed using a

modified stepping test.

Muscular streogth: Degree to which the musnilar system can exert force. This will be

assessed using a hand grip dynamometer.

Muscular endurance: Degree to which one is able to perforrn work repeatedly agauist a

moderate resistance. This wiii be assessed by the administration of a sit-up test and push

up test.

Flexibility: Degree to which one's joints are able to move through the full range of

motion. This will be assessed by administering a sit and reach test.

Percent body fat: An individuai's degree of body fat is estirnated by the summation of

skinfolds thickness taken at four body sites.

Blood pressure: A measurernent of one's systolic and diastoiic blood pressure using a

sphygmonamometer and represented in millimetres of mercury (rnmhg).

Resting Heart rate: The heart rate taken after the participant has remained quietly seated

for a period of five minutes.

Middle Aged: For the purposes of this study middle age will refer to those individuais

between 34 and 57 years of age.

Chapter 2

Review of the Literature

The purpose of this study was to describe the physical fitness of middle-aged

adults with an intellectual disability and how it has changed over tirne. The review of

literature will be organized in the foliowing manner: (2.1) Contemporary Issues in Fitness

and Active Living; (2.2) Age Related Changes in Physical Fitness; (2.3) The Physical

Fitness of Persons with an Inteliectual Disability.

More specificdy, section 2.1 wili explore societal changes in the relationship

between physical activity, fitness, and health. The inclusion of this section is justified by

the fact that not only are perceptions about physical activity changing, but concurrently so

are the perceptions about the capabilities of persons with disabilities. Further, more

opportunities to participate in physical activity appear to be available for persons with a ;

disability which may have direct or indirect influences on health. Section 2.2 will examine

the literature as it pertains to the typical effects of aging on the physical fitness of persons

without a disability. This section will focus on changes of specifk physical fitness

components. Section 2.3 will criticdiy examine information on the unique physical fitness

characteristics of persons with an intellectml disability. This section wiil also criticaily

examine the methods used and the problems encountered when testhg these individuals.

2.1 Contemporary Notions of Physicai Activity, Fitness, And Heaith

The relationship between physical activity, fitness, and health has, in recent times,

become a topic of much interest for those involved with the health and welEve of othen

(Quimey, Gauvin, & Wall, 1994). The goal for ail people in society, including those with

disabilities, is to [ive productive, healthy, and disease fiee lives. Interest and

discussion of this issue is very timely as there is a concem for escalating health care costs a

due to an ever increasing proportion of middle aged and elderly people in society. As

Shephard (1995) points out, questions about the benefits of an active Lifestyle are more

than purely academic, but also issues of govermentai health policy, due to soaring heaith

and chronic care costs.

The debate over exercise for health versus exercise for fitness has corne to the

forefront in evolving perceptions about lifestyle choices. The debate is fùrther compli-

cated by additional issues such as; how much aaMty is swtable to reap health benefits, do a

lower levels of physicai activity have simdar effects than higher intensity activities on

physical fitness, and how do health agencies and govermnents inteiligentiy promote active

lifestyles?

The interdependent relationship between physical activity, fitness, and heaith

merits some discussion. An understanding of the relationship arnong the three issues may

be facilitated by some definition and discussion of each concept. Physical Advi t . is "any

body of movement produced by the çkeletal muscles that results in a substantial increase

over the resting energy expenditure" (Bouchard, Shephard, & Stephens, 1993, p. 1 1).

This definition includes not only activities undertaken for the intentionai purpose of

improving heaith and performance, but daily Living activities where energy expenditure is

equivalent to that of fitness. This definition includes activities in Ieisure pursuits, sport,

work, and activities of daiiy living such as household chores.

Fitness can be defined as the undertaking of moderate to high intensity activity for 1

the sole purpose in irnproving abilities in cardiovascular endurance, rnuscular strength and

endurance, flexibility, rnorphology, motor abiiity, and metabolic function (Shephard,

1995).

Health can be defined as follows:

"A human condition with physical, social, and psychological.. .Positive heaith is

associated with a capacity to enjoy life and to withstand challenges; it is not merely

the absence of disease. Negative health is associated with morbidity, and in the

extreme, with premature morbidity. (Bouchard Shephard, Stephens, Sutton, &

McPherson, 1990, p. 1 1).

The definitions used for this review of literature have been developed f?om a consensus

cornmittee of professionals. They responded to a need for a cornmon understanding of the

tems and thus provide a foundation for further discussion of the pertinent issues related to

the benefits of a healthy and active lifestyle (Bouchard et ai., 1993).

Beginning in the 19201s, the medical cornmunity was very sceptical of persons

beyond school age participating in vigorous exercise (Hoiloszy, 1983). There existed a

negative attitude toward exercise upheld by previous misconceptions about the effect of

vigorous exercise on individuais. It was believed that the greater the energy expenditure

and oxygen consumption the shorter the life-span (Hollosry, 1983). This was termed the

rate of living theory. This theory, developed by Pearl (1928), was coupled with beliefs

that repeated participation in vigorous exercise would contnbute to long-term harmful

physicai effects similar to infections and trauma. No evidence has ever supported the

notion that increasing energy expenditure has a negative effect on heaith, and, as a result,

the rate a living theory is not relevant to today's thinking. In fact, increases in energy

expenditure have been scientifically proven to cause tissues and organs to develop an

adaptive increase in areas of strength and endurance which counters the degenerative

changes that occur with age (Shephard, 1987a). It is worth mentioning that the rate of

living theory has never been disproved and, as a result, investigation into the negative

effects of strenuous exercise on health may have some validity (Holloszy, 1983).

AIthough the scientific comrnunity has not found a way to reduce the aging

process, evidence does exist that exercise may produce effects that can slow the deteriora-

tion of the cardiovascular, skeletal, and rnuscular systems (PaEenbarger et al., 1995). It

has also been suggested that exercise training rnay provide protection against

cardiovascular disease, insulin dependent diabetes, and high blood pressure (Blair, 1995).

This preliminary information about the potential benefits of exercise, which was developed

around the mid 1960's resulted in a t h s t towards govemment and community agencies

promoting participation in vigorous exercise (Holloszy, 1983).

The fitness movement in the early 1980's highlighted an increased awareness of the

benefits of regular participation in exercise and was promoted to be beneficial when

performed at a high intensity, duration, and fiequency. Aithough this was a physiologi-

cally sound concept, adherence to this type of exercise program was very intimidating for

those who were not motivated by the regirnen and who could not h d the time and energy

for such a prescription (Swedburg & Iszo, 1994). The fitness industry's main objective

was to get people fit by prescribing an exercise regimen that was goal oriented in nature.

However, the fitness industry did not necessariiy encompass the idea of living a healthy

and active life (Swedburg & Iszo, 1994). The approach dunng the fitness boom was to

test physical fitness and secondly, to offer activity programs through which participants

would improve their physical fitness. When the goal of physical fitness was attained,

adherence to the prograrn was needed. However, the prospect of performing high

intensity activities in sterile conditions was very intimidating for most people and it was

also demanding on one's tirne and money.

ln order to promote an integrated view of physical activity, fitness, and hedth, the

Active Living movement was conceived. It was boni out of the 1986 Surnrnit on Fitness

(Goverment of Canada, 1986) where leaders from the public and private sector met to

discuss the future of fitness and physical activity. An approach was created which would

be accessible to dl , including persons with disabiiities. It minimized the elitism of the

fitness movement and focused on a view that physical activity and health could be

integrated into al1 aspects of life. Activity would be fun and range in intensity depending

on individual preference. Thus, Active Living was dehed as "a way of life in which

physical activity is valued and integrated into dady Me" (Govemment of Canada, 1992,

p.8). The concept of Active Living was intended to provide a fiarnework nom which

schools, govenunents, and communities can encompass physical fitness, activity, and

health as an intrinsic value within each of its members. One major selling point of the

Active Living carnpaign is that moderate activity is easier for sedentary individuais to

begin when starting firom little or no activity.

It has been suggested that moderate activity is easier for individuals to adapt into

their lifestyles; easier to change if they are inactive; and a more plausible solution than the

intimidating view of high intensity exercise (Casey, 1992). In addition, the moderate

approach is far easier to market to most of the population. It afErms the decision that

every individual is making to become physicaiiy active is valid (Swedburg & Izso, 1994).

However appealing, the idea of Active Living has been questioned with regard to the

foilowing: 1) the interpretation of the definition; 2) measurability; 3) which activities

included in the broad interpretation of active living actuaüy eEect a heaithy Mestyle; 4) to

what degree is the concept of active living related to more established notions of health,

physical activity and fitness; 5) and what is an acceptable level of fiequency, intensity, and

duration to produce sigmficant health benefits. As a result, agencies are challenged to re-

define the strategy they use to promote the concept.

Some authors suggest that the physical activity for fitness orientation towards

Active Living is limiting because it implicitly denies the pçychological, social, and spiritual

benefits to be gained fiom participation in physical activity (Makosky, 1992). However,

Bouchard (1 994b) views the Active Living movement with scepticism. He believes that

the concept of Active Living is too all-encompassing for those who make claims that any

form of activity, whatever the intensity, will produce health benefits; both psychosocial

and physical. It is possible that psychosocial benefits may be gained itom participating

more frequently in leisure t h e pursuits (McAuley & Rudolph, 1995) however, the implied

benefits of some physical activities are subject to protest fiom professionals involved in

physiological sciences. Bouchard (1994b) argues that overall health benefits are best

derived fkom participation in regular physical activity (four days per week) of moderate

intensity (40-60 % of maximum) for a duration of 30-60 minutes. He suggests that, until

empirical research proves otherwise, health professionais must exercise caution when

advocating perceived benefits of participation in light intensity activity.

As one cm well imagine, the Active Living concept did not rise solely out of a

desperation for agencies to get more people active, but rather, responded to new informa-

tion on benefits to be derived fiom moderate exercise (Blair & Powell, 1 994; PafFenbarger

et ai., 1994). Societal changes that were taking place with respect to attitudes towards

health and fitness created a need for agencies to react to the anticipation of the mounting a

hedth care costs of an aging society. Apparently, the interpretation of the Active Living

concept and its daims of improving health are subject to the discretion those involved in

promoting this strategy. Research is needed to substantiate or refute the perceived

benefits of Active Living. Additiondly, an investigation into the availability and accessibil-

ity of programs which support the Active Living concept, especiaily for persons with

disabilities, is greatly needed.

Whether it is fitness programs or personai recreational pursuits, documentation

shows that benefits can be derived fkom increased participation in physical activity (Blair,

Brill &, Barlow 1992; Bouchard, 1994; PafFenbarger et al., 1992). Contemporary notions

of physical activity feature a departure from the physical fitness mode1 of activity towards

a more leisure-recreational orientation. Encouraged by the meaninml research which has

s h o k that general health improvements can be derived from moderate levels of physical

activity (Blair, 1995; Bokovoy & Blair, 1994; Jette, Sidney, Quenneviile, & Landry, 1992;

Wood. 1994), more people are being encouraged to participate in leisure and recreational

pursuits (Stewart, 1995). The seerningly unattainable goals of the fitness boom have given

way to a more holistic view of activity for all people. This idea has potential for opening

doors to a multitude of people who othenvise would becorne discouraged by the unattain-

able standards set by societies' view of the perfect physicaily fit person.

Of the multitude of factors which may have beneficial influences on one's quality of

life (ie. diet, psychological state, etc.) participation in physical activity is seen as one major t

factor contributing to well being (Patfenbarger et al., 1994). Although this research is

encouraging, not al1 the information is accurate or conclusive. In response to this concern

Shephard (1 995) has outlined the research evidence fiom the consensus conference on

physicd activity, fitness, and health (Bouchard et al., 1994) identtfling the benefits of

participation in regular physical activity. Research findings were considered strong,

suggestive, or inconclusive (see Table 1).

Table 1 Evidence of the Benefits of Physical Activity on Eeaith

-Coronary heart disease -VascuIar disease -Cerebrovascular -Hypertension -O besity accidents -End-stage renal disease -0steoarthritis -Type I diabetes -Type II diabetes -Rheumatoid -Back Problems -0steoporosis -Chronic lung -Bladder problems -Cancer (colon, breast) infection -Immune function -Surgical Trauma -Neuromuscular l

-Depression disorders - . * Adapted from Shephard, 1995.

Physical activity has been coined by some as the miracle medicine for a long and healthy

life (Stewart, 1995). Ifsociety's function is to provide adequate and cost efficient health

care to its members, then the promotion of healthy and active Mestyles must be part of its

campaign.

The above information has numerous implications for persons with an inteiiectual

disability. As a traditionally sedentary population (Burkett, Fox, and Rotatori, 1985; Pitetti

& Campbell, 199 1 ), they now have access to a concept of physical activity which is more

attainable and requires less maximal effort. Makosky (1992) calls for an elimination of the

restrictive social attitudes towards specific populations. These attitudes inhibit their

opportunity to participate in regular physical activity. Perhaps the concept of Active

Living, which justifies the value of moderate to minimal intensity activity, will open a door

of opportunity to persons with intellectual disabilities to upgrade a level of physical

activity which has virtually remained dormant and sedentary.

For the purposes of this study, the concept of Active Living, wiu be h t e d to the

information which supports the notion that moderate levels of physical activity of adequate

frequency and duration will irnprove fitness and consequently improve health, reducing the

nsk of disabling conditions as a result of aging.

2.2 Age-Related Cbanga in Pbysical Fitness

Information presented in the previous section of this review suggest that

participation in physical activity may have a positive effect on fitness and health, however,

important issues need to be resolved. Dose-response (ie. the amount of physical activity

needed to reap benefits) appears to be a major area of contention arnong heaith pro-

fessionals (Blair, 1995). Further, while some studies have s h o w that moderate levels of

activity can have an effect on reducing the risk of coronary heart disease, hypertension,

stroke, and cancer (Bokovoy & Blair, 1994), controversy still surrounds the appropnate

frequency, duration and intensity of activity of exercise.

Information about physical activity and exercise and its effect on health is directly

related to a need for researchers to understand the biological effects of aging. Research

on aging has been increasing dong with a recognition that by the early twenty-first

century, there will be a large proportion of baby boomers reaching retirement age (Going

et al., 1994). These numbers will have large ramifications on heaith care costs. Thus,

research is attempting to determine what factors contribute to the healthy aging of rniddle-

aged persons. Consequently, the terminal objective of research in aging is to reduce the

prevalence of age associated diseases and enhance quaiity of life (Baker &: Martin, 1994).

Aging has inherent effects on physical fitness. It has been reported that regardless

of the lifestyle, physical fitness capacity will dccrease with age (Govemment of Canada,

1982; Spirduso, 1995). Despite this fact, gains in physical fitness can be obtained through

diligent and regular participation in physical activity. An examination of the fundamental

effects of aging on physical fitness capacity and physical activity patterns would perhaps

lead to a better understanding of the relationship between physicai activity, fitness, health 1

and how, through an increase in personal fitness, we can improve Our adaptation to the

process of aging (Shephard, l987a).

Large cross-sectionai and longitudinal studies have determined that there is an

association between aging and a decline in certain components of physical fitness (Blair et

ai, i995; Seccareccia & Menotti, 1992). Interestingly this decline can be hrther exacer-

bated by sedentary living (Poweii & Blair, 1992). There exists a typical decline in most

components of physicai fitness components until about the end of middle age (Shephard,

1986). In older age populations the deciine in physical fitness capabilities becomes Iess

typical because previous lifestyle choices appear to have an effect on the health of each

individual. This review wili focus on typical physiologicai changes during the middle-

aged years in physical fitness.

Measurements of height, weight, and skinfold thickness are ofken used to estimate

the body composition. An exhaustive review on the effects of aging and body composi-

tion was performed by Going et al. (1994). Changes in body composition are of particular

concern and have been shown to correlate with deterioration in functionai capacity and

risk of some chronic diseases.

Height increases slowly until about 25 years of age and then slowly decreases

thereafler (Government of Canada, 198 1). More rapid decreases are seen in persons after

age fifty (Spirduso, 1995). Females tend to lose height faster than males due to the higher

incidence of osteoporosis, especially in the few years before and d e r menopause. Some 1

authors suggest that effect of bone loss in women occurs before menopause but is

exacerbated by menopause (Going et al., 1994; Shephard, l987b). Other factors which

iduence a decline in height are diet, heredity, weight, and physicai activity patterns

(Spirduso, 1 995).

Few longitudinal studies exist to track the change in body weight as aging occurs.

Most are cross-sectional (ie. Canada Fitness Survey). By comparing different age groups

with each other, cross-sectional studies have been criticized for creating false impressions

about the tme effect of aging that one would expect when examining the sarne people over

time (Skinner, 1989). Nevertheless, weight has been s h o w to increase during adulthood

until about the age of fi@, with a graduai decline thereafler. Increases in body weight are

usually a result of increases in body fat (Shephard, 198%).

Body Mass Index (BMI) is perhaps a more acceptable hterpretation of weight in t

relation to stature. In relation to skinfolds measurernents, BMI can be used to help

distinguish whether increases in mass are a resdt of increases in body fat or muscle m m .

It is Iikely that an increase in BMI is due to increase in body fat for rnost rniddle aged

people because results show that body fat increases with aging and is more pronounced in

the middle age years (Govemment of Canada, 198 1). Aging trends for BMI indicates that

women tend to increase until60-70 years of age compared with males who stabilize

between 45 and 50 years of age. This information rnay be explained by a substantial

increase in fat for women and a decrease in muscle mass for men (Frisancho, 1990, cited

in Spirduso, 1995).

In contrast to weight, which levels offaround the age of nfty, body fat continues

to increase with age only levelling off around 65-70 years of age for women (Government

of Canada, 198 1). Men have a substantially less body fat compared with women and will

generally level off around 45 years of age. Estimations of body fat, although in need of

carefùl interpretation, have been linked to increased risk of cardiovascular disease (Going

et al., 1994; Wood, 1994). The use of skinfolds measurements to estimate body fat have

been criticised because measurement error has been shown to be higher in older adults due

to redistribution of fat as aging occurs (Bouchard & Despres, 1989). Additionally, risk

factors associated with excess levels of body fat appear to Vary dependinç on the area of

the body where the most fat is distributed. Measurements which indicate abdominal

obesity carries a greater risk for disease than measurements indicating an excess of total

body fat (Going et al.. 1994; Govenunent of Canada, 1987). In fact, the CSTF (Govem-

ment of Canada, 1986) has recommended that taking skinfold measurements of waist to

hïp ratio and sum of two trunk skinfolds may be used to descnbe how the distribution of

fat in certain areas of the body relates to health. As well, some evidence suggests that in

order to effectively determine the health risk associated with obesity, the length of time

one is obese should be accounted for (Going et al., 1994).

The Canada Fitness Survey (198 l), has show that women are more flexible than

men. A decline in flexibility begins in both males and females as early as adolescence and

continues throughout the lifespan. Loss of flexibility because of aging is, in part, due to

decreased use of certain muscle groups (Spirduso, 1995). Some evidence has shown that

less severe loss is seen in tests of trunk flexion than back extension. In one study, the

anterior flexion of females was slightly better for participants who were middle aged as

compared with those in their menties (Einkauf: Gohdes, Jensen, & Jewell, 1987). This

difference may be attributed to the fact that a larger proportion of the movements used in

dail y activities are geared more toward bending forward than bending bac kward.

Flexibility is an important rneasure of physical fitness as it provides an indication of a joint

strength and stability. Poor flexibility may be an indicator of age related diseases such as

osteoarthritis. Little data are available describing changes in flexibility with increasing age.

There is a need for more data on flexibility with age and how it affects individual function- l

ing .

A distinction between muscular strength and muscular endurance must be made

before describing these two components of physical fitness. Muscular endurance is the

capacity to perform work repeatedly against a moderate resistance. Muscular strength is

defined as the degree to which the muscular system can exert force in one contraction. It

has been suggested that a relationship exists between rnuscular strength and rnuscular

endurance: if muscular strength decreases then consequently, muscular endurance will aiso

decrease (Buskirk and Segal, 1988). However, there does not appear to be a linear

relationship between a deciine in muscular strength and muscular endurance (Govermnent

of Canada, 1 98 1 ). Muscular strength tends to increase until the thirties and then remain

fairly constant until about age fifty with a marked decrease thereafter. In contrast, the

muscular endurance of participants of the Canada Fitness S w e y (1 98 1) showed a steady 2

decline throughout the age span. In particular, females showed less decline than males.

This information is in direct contrast to studies which show that muscular endurance is

maintained throughout aging, more effectively than muscular strength (Dumer, Clark,

Vaccaro, Van Velden, Goldfare, & Sockler, 1985). The inconsistency of findings may be

explained by the methods with which these two components of fitness were measured and

the type of training the participants had undergone. Decline in strength has been shown to

be more pronounced for the lower body than the upper body (Viitasala, Era, Leskinen, &

HeiWùnen, 1985). In fact sorne studies show little or no loss in strength when handgrip

measurements are used (Colman, Plato, and Tobin cited in Spirduso, 1995). Dummer et

al, (1985) showed that older women had similar strength as younger women who trained

for the same arnount of tirne but had lower endurance. As Spirduso (1995) explains, the

findings rnay be clarified by the fact that swimming is an endurance activity and although

the younger and older women swarn for the same amount of time, the younger women

swam for twice the distance as the older women. In effect, the younger women needed

more muscular power to swim twice the distance in the sarne arnount of tirne. Thus,

although the information on muscular endurance and strength shows a steady and

sometimes subtle decline as a resuit of aging, interpretations must be made considering the

differences between rneasurement for dinerent muscle groups and types of training

regimes.

The state of cardiovascuiar fitness has been linked to health related nsks such as

ischaemic ha r t disease (Jette et al., 1 992; S hep hard, 1 98 7a), consequently, cardiovascular

fitness has been one of the most thoroughly examined areas in physicd fitness research. In

addition, cardiovascular fitness has been shown to be related to aii-cause rnortality (Blair,

Kohl, Paffenbarger, Clark, Cooper, & Gibbons, 1989). Blair et al. (1989) assesseci fitness

by treadrniil performance and foUowed the subjects for eight years. They found that

rnortality rates were lowest for those who were physically fit and highest for those who

were unfit.

The decline in cardiovascular fitness due to aging is very hard to understand

because, as Jackson et al. (1995) have demonstrated, participation in physical activity and

changes in body composition influence the predictions of Maximum Oxyeen Uptake

( V O T A and thereby act as covariates to the effects of aging. Furthemore, depending on

the type of measurement used, results for VOZrnax can vary. Direct measures appear to

be the best method of determining oxygen uptake (Shephard, 1987a), but they are time

consuming and expensive. Thus, numerous field tests have been developed to predict

maximum oxygen uptake. Some criticism has been express4 when using field tests to

predict V02, especially in epidemiological shidies, as they tend to under or over estimate

the value of VO2 (Whaley, Kaminsky, Dwyer, & Getcheil, 1995). Although direct

measures of VOZmax are considered the best measure of cardiovascular fitness, some field

tests have been shown to be practicd and reliable tools (Montgomery et al., 1982).

1

The Canadian Horne Fitness Test (CEET, 1986) is one field test which bas b e n

cited to have limitations since only a small percentage of the variance in cala i lahg the

predicted VO2ma.x is diected toward the cardiovascular masure of poa exercise kart

rate (S hephard & Bouchard, 1993). As weil, mechanical efnciency of stepphg appears to

be dependant on the ability of the participant to maintain a proper cadence (Seidl, 1986)

and proven to be diilicult for certain groups (ie. the elderly, disabled). Aithough

numerous attempts have been made to modify the CHFT procedures, it has been shown to

be a reliable estirnator of VO2max compared with other common field tests (Montgomery

et al., 1992).

The typical deche in cardiovascular fitness, as meanired by maximal oxygen

intake (VO2max), appears to be related to the decrease in maximum hem rate and in pan

by an age-related Ioss in muscle mass (Spirduso, 1995; Shephard, 198%). Since most

masures of VOZrnax are dependent on the abiiity of the muscles to use oxygen deiivered I

by the lungs, VO2max is highiy dependent on muscle mass. As weii, some evidence

shows that muscles become less effective at extracting oxygen fiom the blood as aging

occurs (Shephard, 1987a). Because fernales lose a nibstantialiy higher amount of muscle

mass and acquire more body fat than men, differences in the amount of work women can

do as compared with men is substantiaiiy lower. Maies have been shown to have VOîrnax

values 10% higher than females throughout the middle age years (Governrnent of Canada,

198 1). One study examineci the factors infiuencing a change in aerobic power in men aged

25-70 years (Jackson, Beard, Wier, Ross, S ~ t d i e , & Blair, 1995). Both longitudinal and

cross-sectional data were used to determine age-related changes in aerobic power. The

authors concludeci that change in aerobic power were not only age-related, but due to the

level of physical activity and percent body fat. Cross sectional designs have been criticised

for being a weak rneasure of age-related changes in cardiovascular fitness because they

represent estimates of changes in VOZmax, as well, older participants who volunteer tend I

to be more physicaiiy fit than those who dont volwteer (Spirduso, 1995). however the

strength of the midy by Jackson et ai. (1 995), is that their longitudinal data supponed

t heir cross-sectional data. When exanYning cardiovascuiar fitness changes with aging, one

must consider the interactive effkcts of level of physical activity, and percent body fat, as

weii as the methods used in the testing.

2.3 Physicai Fitness o f Persons with an Inteiiectud Disabüity

It is well documented that persons with an intellectual disability have substantially 1

lower physical fitness performance when cornpared to the general population of persons

without disabilities (Beasley, 1982; Fernhdl& Tymeson, 1988; Montgomery et ai, 1992;

Moon & Renzagiia, 1982; Pitetti & CampbeU, 199 1 ; Pitetti & Tan, 199 1 ; Reid et al. 1985;

Schurrer. Weltrnan, & Brammel, 1985). Furthemore, females tend to perform more

poorly than males on tests of cardiovascular fitness (Pitetti & Tan, 1991; Reid et al., 1985;

Schurrer et al., 1985). The definition of inteilectual disability in the DSM IV (1994)

includes a list of deficits in adaptive hctioning which are concurrent with the disability.

Deficits range from communication and self-care to work and academic skills. Nowhere is

it mentioned that there are deficits related to physical functioning. However, their is

evidence that some dinerentiation in performance is based on the cause of inteilectual

disability. In their comparative study on growth, maturation, and performance, Beunen,

Breugelmans, Lefevre, Maes, De Corte, & Claessens (1 988) showed that children with a 1

metabolic cause of intellectuai disability (ie. Down's Syndrome, brain damage) had more

severe growth delays than nonpathologicai (ie. funaional, culturai, environmental)

children with intellectual disability.

Although the evidence shows a link between physical performance and

anthropometnc differences, the factors affecting performance are too numerous to draw

conclusions suggesting that low fitness is an inherent characteristic of intellectual disabil-

ity. Montgomery et al. (1987), believe that poor physical fitness is more Likely due to lack

of opportunity in planning and participation in physicai activities. In addition, problems

with processing idonnation and Iack of ability to problem solve may have some effect on

physicai functioning (Bouffard & Wall, 1990). Seidl et al. (1 987) suggested that many

persons with an intellectual disability have shown poor gross motor control which can

affect performance on physical fitness tests, resulting in lower measures of fitness. As

previously rnentioned, dflerences in somatic growth and biological maturation between 1

persons with and without disabilities have been cited as having a strong influence on

performance on physical fitness tests (Beunen et al., 1988; Shephard, 1993). This fact is

important in light of the information which shows that persons with an inteiiectual

disability have a srnalier body size when compared to persons without disabilities (Reid et I

al., 1985). Even when corrections are made to control height and weight, boys with an

intellectual disability have been shown to have poorer motor performance (Dobbins,

Garron, & Rarick, 1981). However, other factors such as muscle weakness, lack of

coordinated movement, and difficulty in understanding the concept of effort and speed

may contribute to poorer performance (Dobbins et al., 198 1 ; Femhd, Tymeson, &

Webster, 1988; Seidl et d., 1987; Tomporowski & EUis, 1984). It is not yet clear to what

extent intemal or extemai factors, or a combination of both, contribute to a lower ievei of

fitness.

In light of the fact that a nurnber of persons with intellectual disability have

additional medical conditions, it is important to note that drugs used to aid and/or control

a physical or psychologicd condition can have an effect on one's physiological response to

exercise (ACSM, 1995). For exarnple, medication for thyroid conditions may increase

heart rate and blood pressure during rest and exercise. Psychotropic medications, used to t

control anxiety, depression, and seizures, may result in an increase in heart rate and a

decrease in blood pressure during rest and exercise. According to the ACSM (1995),

these types of medications have no effect on exercise capacity, however their effect on

heart rate and blood pressure are an important consideration when interpreting scores on

tests of physical fitness using heart rate and blood pressure as factors in the calculation of

physical performance.

Descriptive studies have generally focused on measures of cardiovascular fitness

and obesity. One study, however, comprehensively described the physical fitness of 184

persons with an intellectual disability (Reid et al, 1985). They measured body composi-

tion, muscular strength and endurance, flexibility, and cardiovascular endurance of the

group. The general conclusion was that the physical fitness of persons with an intellectual

disability was inferior to the population of persons without disabilities. The diîferences in

disabiiity was inferior to the population of persons without disabiiities. The differences in

physical fitness was of varying magnitude for each component. This infionnation suggests

that research is needed to determine to what degree each variable contributes to total

fitness.

Reid et al. (1985) established that persons with an intellectual disability were

shorter than but similar in weight to non-disabled adults. Studies have s h o w that there is

a prevalence of obesity for persons with an inteiiectual disability (Burkart, Fox, &

Rotatori, 1985; Fox & Rotatori, 1982; Reid et al., 1985). Most findings show that

females have a higher perceatage of fat than males. As well, obesity tends to increase with

age (Fox & Rotatori, 1982). Researchers use different measures to categorize their

populations as being overweight. Height-weight tables and skuifolds measurements being

the most common methods used to determine excess body weight in persons with an

intellectual disability (Pitetti et al., 1993). BMI has also been used as a measure of excess

fat. However, no information exists to determine the compatibility of these measures and

accordingly, it is difncult to make cornparisons among the dBerent research studies which

link obesity to risk factors such as heart disease and diabetes. Rimmer, Braddock, and

Fujiura (1 994) determined that the congruence between BMI, skùifolds and height-weight

in populations with an intellectual disability is not strong. A number of fdse positive and

negatives were found on each criteria for determining obesity. Since BMI does not

discriminate between the proportion of fat to lean muscle mass, they recommend that BMI

and skinfolds measurements be used to assess at risk status for excess weight. This

information suppons the suggestions of the CSTF Interpretation and Counseiiing Manual

when determining the status of body composition (Govenunent of Canada, 1987). Some

limitations apply to using skinfolds measurements to determine body fat because of the

training and skill involved in taking precise measurements (Rimmer & Kelly, 1987).

Although Fox and Rotatori (1982) have estabiished that obesity increases with age, to

date there is no data to determine the combined effects of aging and level of physical

activity on obesity in persons with an intellectual disability.

Muscular strength has been much more extensively researched than muscular

endurance. Many people with an intellectual disability are involved in work that entails

light to moderate levels of physical labour (Reid et al., 1985). Work performance is

therefore dependent upon an adequate amount of strength and endurance. However, it is

debatable whether they have adequate amounts of strength and endurance needed to

accomplish most moderate physical tasks.

The majority of studies on muscular endurance and strengîh have been field

studies. Measurements of sit-ups, push-ups, and hand grip are used as measurements of

muscular endurance and strength in the CSTF (1981, 1986). These measures have been

criticized because many persons with an intellechial disability obtain scores of zero. Thus,

the measures become inaccurate in predicting potential capability (Horvat, Croce, &

Roswel, 1993). Variable motivation and a lack of ability to exert maximum effort or force

have also been cited as dficulties when assessing muscular strength and endurance l

(Pitetti, 1990; Seidl et al., 1987). In light of these concems, Horvat, Croce, and Roswel

(1993) established that a reliable measure of strength can be obtained using the mean of

three triais when using a hand held device measuring the isometric muscle strength. They

state, that due to the previously mentioned dGculties, the best score from several trials

may not be representative of strength. These data question the reliability of the proce-

dures for the hang grip test in the CSTF (1981, 1986) which uses the best score from two

trials as a measure of muscular strength. In any event, field tests show that adults with an

intellectual disability have very poor levels of muscular strength and endurance when

compared to the general population (Reid et al., 1985). Similar findings for strength were

obtained when using an isokinetic laboratory test (Cybex dynamometer) (Pitetti, 1990).

The results indicated that persons with an inteiiectual disability had low arm and leg

strength. The data on strength and endurance of persons with an intellectual disability is 1

very limited and no data exists regarding aging effects.

With regard to flexibility, Reid et al. (1985), reported that both males and femdes

(27th and 29th percentile respectively) with an intellectual disability had low performance

on a sit and reach test. Flexibility appears to be an often overlooked component of fitness.

Sometimes, when studies have tested flexibility as part of a battery of tests, the perfor-

mance results of flexibility are left out of the discussion section (i.e. Winnick & Short,

1 99 1 ) . Poor flexibility may inhibit a person fiom perforrning daily tasks involving bending

and stretching and may contribute to injury when participating in physical activity 1

(Government of Canadq 1987). Given the implications of poor flexibility, research in this

area is sorely needed.

As mentioned in the previous section, cardiovascular endurance has been the rnost

fùlly researched area in physical fitness and this also holds true for studies involving

persons with an intellectual disability- Generally, fieid tests are used to predict V02 in

persons with a disability because of problems associated with having them perform at

maximal levels vernhall, 1990). SeidI et al. (1987) expressed concern with using field

tests because most have not been validated for persons with an inteliectual disability.

Since the time this concem was expressed, attempts have been made to validate field

measures of VOZ for adults with an intellectual disability (Cressler, Lavay, & Giese, 1988;

Montgomery et al., 19%). Cressler et ai. (1 988) determined that the Balke Ware

Treadmill Test @=.93) and a modified version of the Canadian Home Fitness Test

(CHFT) (R=.95) yielded the highest reliability scores compared to the Cooper Twelve-

Minute Run/Walk (R=.8 1) and the Physicai Working Capacity Cycle Ergometry Test

(R=.64). Sirnilarly, in a study by Montgomery et al. (1992), the CHFT was determined to

be the best measure of aerobic fitness over a submaximal cycle ergometer test and a

maximal shuttle run test. Even though criticisrns have been made with respect to the

regression equation used to predict VOZmax (Leger, 1984), modifications of the CHTF

seem to be a reliable and efficient predictors of cardiovascular fitness for persons with an

intellectual disability. It is important to note, that modifications of the testing procedure

were deemed necessary by Reid et al. (1985), due to the participants' inability to maintain

a desired stepping rate even d e r practice sessions were given. Reid et ai. (1985) had to

record "actud" rather than "recommended" stepping rates. This modification necessitated

the use of interpolated values of the oxygen requirements provided by Jette et ai. (1976)

to predict V02ma.x. l

Most studies have detennined that persons with an inteilectual disabiiity exhibit

much lower levels of performance on cardiovascular fitness tests when compared to

persons without disabilities (Beasley, 1982; Femhall& Tyrneson, 1988; Montgomery et

ai., 1992; Pitetti & Campbell, 199 1; Reid et al., 1985; Schurrer, Weltman, & Brammel,

1985). A paper by Pitetti and Campbell (19911, offers a striking testirnony regarding the

nsks associated with poor cardiovascular fitness. They suggest that the low levels of

cardiovascular fitness in penons with an inteilectual disability are related to sedentary

living conditions and associated accumulations of body fat which may lead to increased

risk of cardiovascular disease. Social factors such as a lack of opportunity to participate

in physical activities, overprotection of parents, and the caregivers lack of ability to

provide for physical needs, further inhibit these persons Born improving their fitness

(Speakman, 1977).

Accurate rneasurement of cardiovascular fitness depends greatly on the

understanding of the test item, motivation to perform the test, and familiarity with the

exercise requirernents for successful completion (Seidl, 1986). Tomporowski and Ellis

(1984) have made several suggestions to ensure that persons with an inteilectual disability

are adequately prepared for tests. They suggest a combination of graduated guidance,

modelling, and verbal instructions. Their subjects had better performance when using

graduated guidance. Researchers must take speciai precautions to control for the many 1

factors which may confound the results of a cardiovascular test. A shortcorning of the

research on the cardiovascular fitness of persons with a disability is that no available data

exists which illustrates the effects of aging on cardiovascular fitness.

Although descriptive studies have painted a bleak picture of the physical fitness

ch&acteristics of persons with an intellectual disability, training studies have s h o w that

physicai fitness can be improved using various modes of exercise. Caution must be made

when interpreting the effects of training programs because of the failure to use valid and

reliable tests of fitness (Pitetti et al., 1993). For exarnple, improvements in performance of

the training regime cm be shown without a concomitant improvement in VOZmax

(Andrew, Reid, Beck, & McDondd, 1979; Millar, Fenihall, & Burkett, 1993). h d r e w et

al, (1979) used a treadmill protocol as their training regime and Millar et al. (1993) used a

walkhn training program. Both studies used the treadrnill for post training evaluation.

The results of these studies imply that both laboratory and field training reghes can

improve performance without sigruficant changes in cardiovascular fitness. In contrast,

two studies using a walk/jog program (Beasley, 1982; Schurrer et al., 1985) indicated

improvements in cardiovascular fitness. Beasley used the 12 minute Copper waik/run to

test Cardiovascular fitness and Schurrer et al. used a treadrnill protocol to predict

VO2max. Pitetti and Tan (1 99 1) found a 16% increase in VO2max after 16 weeks of

training on a cycle ergometer. Subjects were tested before and after on a treadmill and

cycle ergometer, and although there was no control group, a 6 month follow-up showed

that VOZmax values had reverted back to their original values. It is interesting to mention

that Pitetti and Tan (1 99 1) had similar outcornes for the cycle ergometer and the treadmill

on measures of physical fitness.

Problems may be encountered with the interpretation of results fiom fitness

training programs. Failure to spece the duration and intensity of exercise (Pitetti &

Campbell, 199 1), weight reduction during the training program, and initial low levels of

fitness may contribute to improvements in fitness training regimes for persons with a

disability. Most studies which have used traditional group analyses have not accounted

for the high variability in performance of the subjects with an inteliectual disability. Seidl et

al., (1987) suggested that due to the characteristic level of intra and inter-individual

variability, traditional group designs measunng the effects of programmùig on physical

fitness may be inadequate. Others have been strong supporters for the use of single

subject designs and individual analyses to highiight and explain the nature of variable

performance for persons with an intellectual disability (Bouffard, 1993; Watkinson &

Wasson, 1984).

In surnmary, research in the area of fitness for persons with an intellectual disability

has show that they generaily have lower levels of physical fitness than persons without

disabilities. This low level of fitness is not likely due to some inherent characteristic but

more likely to a sedentary lifestyle and a lack of opportunity to participate in recreational

activities. However, low stature and poor motor control may have an effect on perfor-

mance of physical fitness tests, overshadowing one's tme potential. Training programs

have been shown to improve fitness but adherence to these programs is difficult. Most

irnportantly, research on the effects of aging on the physical fitness of persons with a

disability is virtually nonexistent. In section 2.1 the nsks associated with low levels of

physical fitness were discussed. Pitetti and Campbell (1991) discuss these nsks in relation

to the information showing a low level of fitness in persons with an inteilectual disability.

They cite evidence establishing that persons with an intellectual disability have an earlier

onset of physical old age and a higher mortality rate than the general population, that

comrnunity dwellers have considerably more cardiovascular disorders than those in

institutions, and that young adults with an intellectuai disability have cardiovascular fitness

levels indicative of a sedentary lifestyle. This evidence strongly suggests that persons with

an intellectual disability have a faster rate of decline in physical fitness than the general a

population. Consequently, they recomrnend that future studies thoroughly investigate the

effects of aging on physical fitness and determine whether the rate of physical fitness

decline is of a greater magnitude than the non-disabled population. The need for this

preliminary data is paramount to the understanding of the relationship between poor

fitness and early onset of chronic disease. Additionally, if the decline in fitness is similar to

the decline in persons without disabilities, and aven the already low levels of physical

fitness, the cardiovascular fitness of persons with an intellectud disability wiii be low

enough to seriously prevent the average person from performing light work duties

(Shephard, 1993). Consequently, as they become older, many will have to discontinue the

type of work often available to them. Not to mention the decrease in their own quality

and enjoyment of life, as well as, their ability to participate in the comrnunity with others

through work activites. A loss of functional capacity would result in a loss of independ- I

ence placing enormous burdens of responsibility on economic and health care services.

Chapter 3

Methodology

The purpose of this study was to describe the physical fitness characteristics of a

group of adults with an intellectual disability and compare these results to their level of

physical fitness 13 years ago. The methodology of this inquiry is described in the follow-

ing sections: (3.1) Participant Selection, (3.2) Apparatus, (3.3) Procedures, (3.4) Control

of Extraneous Variables (3.5) Training of Experimenter(s), (3.6) Treatment of the Data.

3.1 Participant Selection

Participants were selected from one readaptation center employing adults with an

intellectual disability who participated in a previous study (Reid & Montgomery, 1983).

The experirnenter worked for six years at the readaptation center and was farniliar with

most participants. FQ-six participants fiom a study examining the effects of a physical

fitness program on workshop employees with an intellectual disability (Reid & 1

Montgomery, 1983) were mailed a description of the present study with informed consent

documents. Forty-eight participants responded to the mailing. Of the 48 who responded,

12 participants were screened out of the testing due to some type of physical disability. It

is important to note that these 12 participants were able to perform the tests in 1983 but

due to an acquired or degenerative disability were unable to participate in 1996. In addi-

tion, two participants refused to participate. Lnformation about the participants who were

screened out or refused to participate in the testing is contained in Table 2.

Thirty-four people passed the screening procedure (Physical Activity Readiness

Questionnaire (rParQ), 1992) and agreed to participate by retuming signed consent forms

to the researcher. Of the 34 participants who agreed to participate in the study, 32 were

able to complete the testing. The other two participants were unable to complete the

testing due a lack of motivation. The participants had an age range between 34-57 years,

with a mean age of 41 -2 years. Of the 32 participants who completed the testing, 14 were

fernales and 18 were males.

Table 2 Reasons for Subiects not Particiriatine in Studv

Reason for not Participating # of subjects

Did not respond to request Refused Partial paralysis on one side of body Wears brace on both legs for bad knees Compressed vertebrae from a faIl Heart condition Recently had epileptic seuures Severe Arthritis and Osteoporosis Hydrocephalic condition-uses a wheelchair Hip replacement surgery Muscular Dystrophy Cystic Fibrosis Back condition

The 32 adults with an intellectual disability were tested at either a day center which

is part of the readaptation center or at their residence. Each of the participants had been I

selected for the 1983 study and were chosen at that time to meet the foiiowing criteria: (a)

be between the ages of 20-39 years, @) be employed by a training center, (c) be ambula-

tory and fiee from gross motor difficulties and medical conditions preventing participation

in the exercise program, (e) not currently involved in regular exercise and ( f ) have signed

consent to participate from a legal guardian. Participants selected for the current study

met al1 of the above criteria with the exception of cnteria (a), participants were now

between the ages of 34 and 57, and cnteria (e), as the focus of this study is on the current

state of physical fitness regardless of involvement in physical activity. IQ scores were not

available, however, these participants were classified as moderately to mildly intellectuaily

disabled in the 1983 study (Montgomery, Reid, & Seidl, 1987).

Informed consent was obtained from each participant and their legal guardian prior

to testing. In addition, approval was obtained from the Ethics Cornmittee of the Faculty of

Education, McGiii University.

3.2 Apparatus

The Canadian Standardized Test of Fitness (CSTF) (Government of Canada,

198 1) was administered during one session Iasting approxirnately 1 hour. The testing

battery measured five components of physical fitness: cardiovascular endurance, flexibility,

body composition, muscular endurance and strength, and consisted of the following

measures: (a)anthro pometric measures of standing height and weight ; (b) body- fat

estimates f?om skinfolds measurements at the foiiowing sites: triceps, biceps, subscapular,

and supra iliac; (c) strength rneasurement via a grip-strength score (sum of right and left

grip); (d) rnuscular endurance measurements consisting of the number of sit-ups and push-

ups -performed; (e) flexibility measurement of trunk flexion; and (f) cardiovascular

endurance measurements with a step-test protocol. The procedures outlined in the C STF

operations manual (Government of Canada, 198 1) was employed for al1 tests with the

exception of the Canada Home Fitness Test (CHFT). A modified version of the CHFT

was recommended (Montgomesr et al, 1985) as subjects with intellectual disabiîity have

been s h o w to experience difficulty maintaining the proper cadence when stepping.

Physical Fitness Variables

An thropometric Variables

Anthropometric data collection followed the procedures outlined in the CSTF

operations manuai (198 1) and included measurements of Height, Weight, Surn of Five

Skinfolds measurements. Information about testing procedures and equiprnent used for

these measurements may be found in Appendix A.

Muscular Streogth and Endurance Variables

Muscular strength was evaluated using a hand-grip dynamometer to obtain a

measurement of the sum of right and Iefi hand grip strength. Muscular endurance was

measured by number of sit-ups and push-ups. The procedures contained within the CSTF

(Government of Canada, 198 1) were employed for both masures. information describing

the testing procedures and equipment required may be found in Appendix B.

Fiexibility Variable

Testing procedures outlined in the CSTF manual (Government of Canada, 198 1)

for the Sit and Reach Test were a d d s t e r e d to measure the flexibility of each participant.

Information regarding the equipment needed and testing procedures rnay be found in

Appendix D.

Cardiovascular Endurance Variable

The procedure for the Canada Home Fitness Test (CHFT) from the CSTF Manual

(Govenunent of Canada, 198 1) was modified for this study. The modification was

necessary because "many participants experienced difficulty in attaining and maintaining

the required stepping cadence" (Montgomery et al. 1987, p.75) recommended by the

testing procedures. The results of the CHFT were placed into a regression equation

provided by Jette, Campbell, Mongeon, and Routhier (1976) and used to predict VO,.

The regression equation produced a correlation of 0.90 between the predicted VO,,

using the equation and a direct measure on a treadmiil test with participants without a

disability (Jette et al., 1976). In the 1983 study, the modified version of the CHFT was

s h o w to be reliable with the regular version of the test producing a correlation of 0.84

(Montgomery et al., 1988). When compared to submaximal tests of cycle ergometry, I

shuttle test, and treadmill, Montgomery et al (1992) concluded that the optimal approach

to predicting VOZmax was via the use of the modified CHFT. The conclusion was based

on test-rest reliability and validity relative to the treadmill test. Montgomery et al. (1992)

used a modification of the regression equation used to predict V02max and of the method

of taking the final stage exercise heart rates. These modifications, althouçh more reliable

than the original procedures for the CHFT, were unable to be used in the present study

because the comparative analysis necessitated the use of the exact protocol of Reid and

Montgomery. (1983). Nonetheless the C H 3 appears to be a vaiid and reliable predic-

tion of cardiovascular endurance. Appendix F offers information concerning the modifieci

testing procedures and equipment used for the Canada Home Fitness Test.

3.3 Procedures

In accordance with the ACSMs Guidelines for Exercise Testing and Prescription

(ACSM, 1995), a rPar-Q questionnaire was aven to each participant prior to the testing

day. The rPar-Q screened out any individuals who had risks associated with exercise

testing (see Table 2). In addition to the Par-Q, information regarding medication was

sought as the use of certain medications have an effect on exercise capacity (ACSW

1995). In order to re-familiarize the participant with the tester, the tester visited each

participant at his or her home. At this t h e , each participant was given a set of pretest

instmctions describing the testing and how to prepare for the testing day.

The testing for this investigation consisted of the items presented in the preceding

section. Each participant was given the complete battery of tests during one testing

session lasting approxirnately one hour. The sequence of the tests was administered as

follows: 1) recording of anthropornetric masures in the following order: weight, height,

and skinfoldg 2) administration of hand grip strength, 3) administration of blood pressure

and resting heart rate 4) administration of the Canada Home Fitness Test 5 ) administration

of the remaining tests in the following order: push-ups, trunk flexion, and sit-ups. The

above sequence has been recommended by the CSTF operations manuai (Governrnent of

Canada, 198 1) and has b e n chosen to reduce any error occurring with the skinfolds

measurernents which may be caused by body perspiration. Data sheets for each partici-

pant recorded personal information as well as the scores obtained for each test. The

scoring sheet rnay be found in Appendix L.

3.4 Control of Extraneous Variables

AI1 participants were asked to refrain from eating, drinking coffee, and smoking

cigarettes two hours before the time of testing and not to exercise the day of the testing

(ACSM, 1995). Explanation o f each test, as well as, farniliarization with the testing

procedure, was made to each participant in an effort to reduce anxiety. This is extremely

necessq since increases in heart rate can be provoked by anxiety and ingestion of

narcotics (ie: cafFeine and nicotine) or food (ACSM, 1995). Attention was given to the

following prior to testing in an effort to help put the participants at ease: (1) participants

were introduced to the tester(s) before the testiag. Most participants have known the

tester for six years pnor to the testing; (2) testing equipment and procedures were fùlly

described to each participant; (3) the temperature of the room was maintained at an

appropriate temperature for exercising (68-729); (4) the test room was decorated with

posters and pictures, striving to minunize the impact of a sterile laboratory environment

(Seidl, 1986); (5) a guardian of the participant was present to help ensure the participant

was cornfortable and relaxed.

Motivation has been cited to be a problem when testing persons with an intellec-

tua1 disability (Seidl, et al., 1987). Therefore, in order to try and control for a potential

lack of motivation, positive reinforcement through encouragement and prise was given t

throughout the testing for both successful and unsuccessful efforts made at completing the

testing items. In order to remain consistent across participants, verbal encouragement (ie:

well done, good job, you can do it, etc.) was given for every completion or attempt to

complete a sit-up and push up. Verbal praise (ie: well done, excellent) was given at the

completion of the sit and reach and band grip tests. Verbal encouragement (step-up, step

down, step-up, step-down) was given throughout the testing on the step test. In addition,

the participant was given verbal praise every 30 seconds (well done, good job, excellent).

Physical prompting and practice were needed for some participants who had dficulty

leaming the tests through solely verbal instructions.

3.5 - Training of Experimenter(s)

An observer/assistant who has known the participants for 20 years was trained by

the experimenter on al1 the tests used in this study. More specificaiiy, the

observer/assistant was trained to observe and count the number of ascents on the Canada

Home Fitness Test, the number of sit-ups and push-ups, and mesure the sit and mach

test, as well as, observe the participants for any critical signs of physical stress which could

have necessitated having the participant discontinue the test. A sphygmornanometer with

built in microphone giving a digital readout of blood pressure and heart rate, was used for

al1 participants and provided the consistency of measurement needed to obtain reliable

data across participants.

3.6 Treatment of the Data

Raw scores fiom the five dependant rneasures were obtained, converted into

percentile scores (CSTF Norms, 198 1, 1986) placing each individual within a percentile

ranking, and then compared to national averages contained within the CSTF operations

manual (1 98 1 ). Using the statistical program " S ystat" descriptive statistics were obtained

featuring the performance of each individual as well as the group.

Individuai data helps to shed light on the individual nature of the performance of

persons with an intellectual disability. It has been suggested and agreed upon (Bouff'd,

1993; Watkinson & Wasson, 1984) that individual data may give a clearer picture of the

performance of participants with an intellectual disability and is sometimes warranted

when experimental groups are low in nurnber and inter-individuai variability is large. I

The main interest of the study necessitated a more traditional statistical approach

to analysing the data. In order to test the stated hypotheses, a 2-way time x group

multivariate analysis of variance was performed. Five dependant variables representing

cornponents of physical fitness were used in the analysis. These dependant measures were

cardiovascular endurance (VOh., muscular strength (hand grip strength), muscular

endurance (push-ups and sit-ups), and flexibility (trunk flexion). To test for the magnitude

of change in physical fitness over the 13 year period effect sizes for the sample were

compared to effect sizes in the population. The population group is defined by special

tabulations of the noms 6om the physical fitness tests employed in this study received

from The Fitness and Lifestyle Research Institute (CSTF Noms, 198 1).

Three levels of anaiysis are presented. First, individuai data on each variable will be

presented. As previously mentioned, it has been suggested that individual anaiysis may

provide meaningful information about results when dealing with populations that have a

high variability of performance (Bouffard, 1990, Watkinson & Wasson, 1984). Tables for

each variable will list each participant's raw score and percentiie score for his or her age

group. Each participant is numbered and labelied according to gender (ie. 10F= partici-

pant 10 and fernale). Percentile scores were calculated by interpolating the values con-

tained in the noms and percentile tables contained within the Canadian Standardized Test

of Fitness Operations Manuai (Govemment of Canada, 198 1, 1986). Percentiles fall

within each participant's age grouping and are not reflective of the effects of aging.

Descriptive terms contained within the noms and percentiles tables will be used to

categorize the state of physical fitness for a given variable.

Second, a repeated measures analysis of variance was performed for each variable

to test the hypothesis that significant change was found in fitness between 1983 and 1996.

Due to the large nurnber of variables being measured on each participant, an omnibus test

of significance was performed to protect for experiment-wise error. The omnibus test of

significance resulted in significant ciifferences for the following: a p=0.000 for the effect of

measure, a p=0.002 for the effect of time, and a p=0.000 for the interaction time on al1

measures (see Table 3). Thomas and French (1990) state that if the variables show no

association then they "could be considered independent (p. 262)" and accordingly, treated

as such. If the variables are correlated, however, the alpha Ievel should be adjusted for

experiment-wise error (Glass & Hopkins, 1984). The results of the omnibus test of

significance revealed that the dependent variable rneasures are independent of each other

and therefore no adjustment of alpha is necessary (M. Hoover, personal communication,

luly, 1996).

Table 3 Omnibus Test of Si~nificance on 9 Dependant Measures

SOURCE GENDEW ERROR

SOURCE Memure Memure "GENIBERS ERROR

Time Time*GEM)ER% ERROR

Measure*Time Measure*Time 'GENDEM ERROR

Each dependent variable was also examined for gender effects. Gender differences 1

for persons with an intellectual disability in physical fitness testing have been noted in

previous studies (Pitetti & Tan, 1990, Reid et ai, 1985). In addition, the noms and

descriptive statistics fiom the Canada Fitness Survey (198 1) are divided by gender. For

the purposes of comparative analysis the data obtained were presented for both males and

females. The results of the analysis of variance for each dependent variable will be

presented in Table format.

Third, in order to test the magnitude of change in fitness for the sarnple as

compared to the magnitude of change in the general population, caiculation of effect sizes

was computed. Weighted means and pooled standard deviations were used to calculate

the effect sizes. Effect sizes will be presented in Table format for each variable measured

in this study. Effect size calculations for the population were made possible with the use

of descriptive statistics obtained fiom the Fitness and Lifestyle Research Institute, based I

on data taken fiom the Canada Fitness Survey (Governrnent of Canada, 1 98 1).

Interpretation of effect sizes wiil follow the suggestion of Thomas, Salazar, and Landers

(1991) by using Cohen's (1988) categories for the interpretation of effect sue. An effect

size less than 0.4 1 will be considered srnail, f?om 0.4 1 to 0.70 moderate, and greater than

0.70 large. Moreover, small sample sizes may cause an effect size to become positively

biased by 20% (Hedges, 198 1). To obtain a virtually unbiased estimate of effect size a

correction factor obtained with the foiiowing formula was multiplied by the sample effect

size (Thomas & French, 1990):

where: c = correction factor

NI= sample size group # 1

N,= sample size group #2

Cbapter 4

Resuiîs

The purpose of this study was to describe the physical fitness of middle-aged

adults (34-54 yrs) with an htellectual disability and how their fitness has changed over

time. Chapter 4 will provide results fkom data collection of Rine dependant variables and

will be organized in the foiiowing manner: (4.1) Reliability, (4.2) Anthropometnc

Measures, (4.3) Muscular Strength, Endurance and Flexibility; (4.4) Cardiovascular

Endurance.

4.1 Reliability

A one-way Random ANOVA Mode1 (Safnt, 1976) was used to calculate intra-

class correlation scores for stability of al1 variables. The scores are as follows: Maximum

Oxygen Uptake (VOZmax) (.98), Height (.99), Weight (.99), Percent Body Fat (.98), Sit-

ups (.93), Push-ups (.go), Hand Grip Strength (.98), Flexibility (-85). The data collected

appear to be reliable as the intraclass correlation scores are high (Glass & Hopkins,

1984).

4.2 Analysis of Anthropometric Variables

The individual results for the anthropometric measures of height, weight, body

mass index, percent body fat can be found in Table 4. In interpreting the percentile values,

it should be rernembered that percentile scores are ranked according to the age of the

participants. An increase or decrease in physicai fitness measurernent is a no& part of

the aging process. Therefore, if an individual increases or decreases at the expected

pattern, percentile scores should not markedly change. Percentile scores that change

dramatically rnay be an indication of decline or improvement in fitness beyond the

expected changes due to aging in comparison to peers.

Table 4 Anthro~ometric Individual Results

Hei~ht (cm)* Weieht (kg)* Badv M u s Index Body Fat(%)

Subject Score %Me Score %ile Score %ile Score %ile

#Ser Age Year

Table 4 (cuntinued)

Heivht (cm)* Weteht (kg)* Bodv Mmss Index Bodv Fat(%)

Subject Score %Ne Score %ile Score %ile Score %ile

#Ses Age Year

37.5 17.0 56.7

Table 4 (coatinued)

Heinht (cm)* Badv Fat(%)

Subject Score %ile Scorc %ile Score %ilc Score %Ile

#Ses Age Year

4.2.1 Eeight

The group results for height found in Table 5 for males and females, indicate that

the persons with an intellectual disability in this study can be descnbed as having "Below

Average" height in cornparison to the persons without disabilities (CSTF, 1986). The

males had a mean percentile score of 27.7 in : 983 and 30.4% in 1996. Females had mean

percentile score of 26.3 in 1983 and 28.6 in 1996. This is consistent with fhdings fiom

other studies which identG persons with intellectual disabilities as having shorter stature

than the general population (Reid et al., 1985; Shephard, 1993).

Of the fourteen female participants, nine were considered to have "Below Aver-

age" height, four participants were "Average" height, and one participant was "Above

Average". The recorded measures in height between 1983 and 1 996 for three females

indicate a jump into a higher or lower category. Participant 9F and 14F had an increase in I

height and participant 12F a decrease in height of 5.1 cm. AU male participants remained

within the sarne descriptive category according to their age as in 1983. The large

magnitude of difference for the three female participants may be due to experirnenter error

between the testers in 1983 and 1996. However, some evidence suggests that females

lose height at a faster rate than males (Spirduso, 1995). This height decline in fernales

may be aaributed to the fact that they reach their peak height at an earlier age than men

and that many develop osteoporosis. This is discussed fùrther in Chapter 5 .

Table 5 presents the results of a repeated measures analysis of variance for height

including males and femaies.

Table 5 Repeated Measures ANOVA and Descriptive Results

for Heieh t

BETWEEN SüBJECTS

Gender 1 1656.259 5.960 0.021

Error 28 277.895

WITHIN SUBJECTS

Time 1 44.674 28.36 0.000

Timex gender 1 0.350 0.222 0.64 1

Error 30 1.575

DESCRIPTKVE RESULTS

YEAR

- - -

Females 155.1 11 26.3

f ales 165.2 12.2 27.7

Both males and females expenenced significant change in height over tirne. This

finding is cornmon as the difference in means between this sarnple and the data taken fiom

the Canada Fitness Survey (198 1) are fairly sirnilar. Table 6 indicates that small effect

sizes were found for both the males and females with intellectuai disabilities (males= .15;

fernales=. 14). Although the analysis of variance indicates that the change in height over

time is significant, the magnitude of change for height is actually small and remains con-

sistent with the effect sizes of the population. t

Table 6 Cmn~arison of Effect Sues for Height

Population ES

Male - . I l

Female -.O9

4.2.2 Weight

Table 4 presents the individual results for weight of each participant. Both male

and female participants are descnbed as having "Below Average" weight in 1983 and

"Average" weight in 1996 (CSTF manual, 1986). A move fiom "Below Average" to

"Average" indicates an increase in weight.

In 1983, five female participants were described as having "Above Average"

weight, two were "Average" and, five were described "Below Average". in 1996, five

female participants were "Above Average", six were of "Average" weight and, three were

described as "Below Average". Of the fourteen female participants, four gained enough

weight to move them up one descriptive category and one female participant moved up 1

two categories. Two female participants lost weight, one moved d o m a category and the

other remained in the sarne category.

Table 7 profiles the results of the repeated measures analysis for weight.

Table 7 Re~eated Measures ANOVA and Descriptive Results for Weieht

ANOVA RESULTS

BETWEEN SUBJECTS

Gender I 463.736 1.522 0.227

Error 30 304.6 13

WITEIN SUBJECTS

Time 1 214.878 5.888 0.021

TimexGender 1 19.030 0.52 1 0.476

Error 30 36.492

DESCR IPTlVE WSULTS

YEAR

Fem ales 58.1 12.5 34.2

Males 64.6 13.8 25.6

The means indicate that both the males and female groups gained weight over the

two testing sessions. Interestingly, one participant in particular lost 2 1.1 kg., iilustrating

the variable nature of the raw data scores. Of the femaies, two participants lost weight J

over the two testing sessions, however, these weight Ioses were minimal in cornparison

with the males. Participants had a sigruficant effect of time. Males and females were not

significantly different from each other and no interaction was found.

Table 8 contains information relating to the magnitude of dzerence in weight

change as compared to the population.

Table 8 Cornparison of Effect Sizes fES1 for Weieht - - - -

Population ES Sample ES

Male -14 .22

Female -26 .39 - - -- - -

Males with an Intellectuai Disability had an effect size of 0.22 as compared to the eEect

size of 0.14 for the population. Both may be considered to be representative of srnail

changes in weight. When compared to the small effect size of the femaie population, the

female group approached a medium effect sue of A O .

4.2.3 Body Mass Index

Body Mass Index @MI) has been identified as one method of determining the 1

proportional weight of the person(s) being tested. However, one must exercise caution in

using this measure, since an increase in BMI rnay be the result of either excessive body fat

content or an increase in muscle mass. In order to determine the cause of an increase in

BMI one rnay consider the Sum of Skinfolds (SOS). Ifthe SOS is also hi&, tthen an

excess of body fat is the logicai cause of the increased BMI (CSTF, 1986).

Table 4 presents the individual data for Body Mass Index (BMI) and Table 9

provides the group, male and female results. A significant effect was found for tirne

(p=O. 00 1). Nonsignificant effects were found for gender and the interaction. The females

percentile ranking for 1983 was 40.4 and 28.0 in 1996. These rankings indicate that the

females have a "Below Average" measure of body mass index. The maies remained fairly

consistent over time with a mean percentile of 59.6 in 1983 and 55.1 in 1996. Their

rankings indicate an "Average" height-weight ratio. The individual data appears to

describe the variability among participants and perhaps illustrate more precisely the

changes associated with age for BMI.

In this study, both males and fernale groups demonstrated significant

change in BMI fiom 1983 to 1996. Since both groups also have significant increases in

percent body fat, the results for BMI may be interpreted to be the result of an excess of

body fat for both genders.

Table 9 Re~eated Measures ANOVA and Descriptive Results for Bodv Mass Index

BETWEEN SUBJECTS Gender 1 34.095 0.863 0.360 Error 30 39.495

WITH-IN SUBJECTS Time 1 73.713 14.537 0.001 TimexGender I 3.546 0.699 0.410 Error 30 5.071

DESCRIPTIVE RESULTS

YEAR

Females 24.4 6.7 40.4 Males 23.4 2.8 59.6

Table 10 outlines the effect sires in BMI for both the population and the sample.

Both males and females had moderate changes in BMI compared with s m d changes

expected for the population.

Table 10 Com~arison of Effect Sizes for BMI

Po~ulation ES Samole ES CROUP

Male

Female

4.2.4 Percent Body Fat

As mentioned earlier, BMI and percent body fat, viewed together, give a clearer

picture of body adiposity. If a person has a high or low BMI, caiculation of percent body

fat can determine whether a high or low BMI is associated with fat content (CSTF, 1986).

The group results found in Table 11 indicate that males had an "Average" amount of body

fat in 1983 (mean percentik 59.6) and an "Above Average" arnount of body fat in 1996

(mean percentile= 38.2) (CSTF, 1981). Females are described as "Obese" in terms of

body fat in both 1983 (Mean percentile = 1 1.9) and 1996 (mean percentile=4.1). (CSTF,

198 1). Increases in body fat are a normal part of aging. However, some individual results

indicate changes in body fat are of a greater magnitude than would be expected through

aging. The followuig paragraph will describe these changes.

In 1983, eight females were described as "Obese", two as having "Above Average"

body fat, and one as having an "Average" arnount of body fat. In 1996, ten females were 1

described as "Obese" and, one femaie as having an "Average" amount of body fat. Two of

the women increased their body fat from "Above Average" to "Obese" (F3, F6) between

1983 and 1996, al1 other women except for one remained categorised as "Obese" in 1983

and. 1 996.

In 1983, one male was described as "Obese", five as having "Above Average"

body fat, six as having "Average" body fat, two were described as having ideal body fat

and three were descnbed as "Slim" (CSTF, 1981). In 1996, 7 males were described as

"Obese", two as having "Above Average" body fat, five as "Average", three as "Ideal",

and one as "Slim". Of the males measured in this study, ten had increases in body fat to

the extent where their description changed. Some dramatic increases were recorded as in

the w e of participant Ml5 whose increase in body fat resulted in a change of ranking

f'rorn "Ideai" body fat to "Obese". Interestingly, five male participants had decreases in

body fat, resulting in a change of their descriptive ranking to a more positive status.

Table 1 1 Re~eated Measures ANOVA and Descri~tive Results for Percent Bodv Fat

-

EFFECT d f MS F P - -

BETWEEN SUBJECTS

Gender 1 1792.833 46.915 0.000 Error 26 38.2 14

WITHIN SUBJECTS

Time 1 478.22 1 34.086 0.000 TimexGender 1 8.904 0.635 0.433 Errot 26 14.030

DESCRIPTIVE RESULTS

Fernales 29.6 4.9 11.9 Males 18.9 4.7 50.6

Reporting the skinfolds thickness is now considered a more accurate measure of

body fat. The equation used to predict percent body fat has been shown to be subject to

error (CSTF, 1986). In this shidy, estimates of body fat are reported in ternis of percent-

ages. Even though it is suggested that the sum of skinfolds measurements may be more

accurate predictors of body fatness, the researcher had to report the results in percentages

as was done in 1983. For the purposes of cornparison, percentages are the most appropri- 1

ate measures to be used for this study.

The results of the repeated measures ANOVA in Table 1 L shows that signifiant

differences were found for the main effect of gender and time. The means indicate that the

females had a significantly greater increase in percent body fat than the males. in 1983

(Montgomery & Reid), the trained graduate students were unable to obtain skinfolds

measures for three female participants. The signifcant changes in both percent body fat

and BMI demonstrate that the participants in this study have had sigdicant increases in

body adiposity over the 13 year period.

Table 12 contains the results fiom the calculation of effect &es depicting the

magnitude of change in percent body fat over 13 years. The effect sizes for both male and

female members of the population can be described as "Srnail". The effect sizes for both

male and female participants can be described as "Large". This idormation suggests that

the body fat content of persons with a disability in this study is an area of concern, since 1

the change is much larger than what would be expected in the general population.

Table 12 Com~arison of Effect Sizes for Percent Body Fat

Population ES Sample ES GROUP

Male

Female

4.3 Muscular Endurance and Strength

4.3.1 Grip Strength

The group results for Grip Strength are contained within Table 13 and the

individual results for males and females are included in Table 14. The group data indicates

that both male and female participants improved their hand grip strength. The analysis of

variance indicates that these changes were sigruficant. The significant increase in grip

strength is contrary to patterns of changes in strength as people age (Govenunent of

Canada, 1982; Spirduso. 1995). The instrument used for grip strength in 1996 was one of

six identicai instruments used to record data in 1983. The hand grip dynamometer used in

1996 was calibrated with a 9-kg weight. Moreover, an intra-class correlation coefficient

of -98 was obtained during retesting of 10 participants in the 1996 portion of the study.

The unexpected dEerence in scores from 1983 to 1996 are difficult to explain as no

records of calibration or reliabiiity measures between the hand grip dynamometers used in

1983 are available. Explmations for the differences in measurements may be due to

variability in performance which is typical in populations with inteiiectual disabilities (Seidl

et ai. 1987) and possibly due to fluctuations in motivation or some form of measurement

error. Since the significant increase in strength over 13 years is contrary to expectations, 1

no fùrther discussion will take place with respect to Grip Strength. One point of interest is

that although the percentde scores increased for both males (1983= 3.4; 1996= 12.6) and

females (1983= 1 -7; 1996= 16.3) both groups still are described as having "Poor"

performance of grip strength (Government of Canada, 198 1).

Table 13 Re~eated Measures ANOVA and Descri~tive Results for Grip Streneth

BETWEEN SUBJECTS

Gender 1 11294.867 17.172 0.000 Error 30 657.76%

W m SUBJECTS

Time 1 3356.175 56.508 0.000 TimexGender 1 201.966 3.400 0.075 Error 30 59.393

DESCRIPTIVE RESULTS YEAR

Females 17.9 11.9 1.7 Males 48.3 21.0 3.4

Table 14 (continuetl) -- ---

Hvnd Grip (ka f ush-Uns (no.) Sit-Uns(no in 60secJ Flexibilitv (cm) Subject Score %Ue Score %Ue Score %ile Score %Ue #Sel Age Year

Table 14 (continued)

Hand Grip (kg) Push-UDS (no.) Sit-Upsho in 60sec) Fleribilitv (cm) Subject Score %ile Score %de Score %ile Scam %Ue #Ses Age Year

Table 14 (continued) -

Hand Grip (kg) Push-Ups ho.) Sit-Upsho in 6Osec) Flesibilitv km) Subjecî Score %île Score %ile Score %iJe Score %ile #Sex Age Year

Percentiles taken from CSTF. 198 1

4.3.2 Push-Ups

Pusli-ups are considered a mesure of muscular endurance (CSTF, 198 1).

Performance of the maximum number of push-ups can be described as "Below Minimum"

for males in both 1983 and 1996. Femaies cm be descnbed as perforrning a "Minimum"

number of pushups in both 1983 and 1996. Ail male participants were able to cornplete

this test, however; in 1996, three male participants scored O on this measure as they were

only able to perform pushups fiom their knees. In the 1996 phase of the study, two

fernales were unable to leam how to perform the pushups according to the procedures

outlined in Appendix C.

The individual results for pushups from 1983 show that one male pariicipant was

described as having "Poor" performance, eight are descnbed as "Below Minimum", seven

as "Minimum", and one as "Good". In 1996, three participants were described as having

"Poor" performance, seven as "Below Minimum", five as "Minimum", and one as "Good".

Of the 18 male participants, six performed poorer in 1996 compared to 1983 resulting in a

change in their descriptive category. Two participants had improved scores dso resulting

in a change of their descriptive category. The fernales appeared to perform better than the

males in terms of their Ievel of performance in pushups. In 1983, six females had a "Below

Minimum" performance as opposed to three in 1996. Four female participants are

described as "Minimum" compared to five in 1996. One participant was descnbed as

"Good" in 1983 compared to four participants falling into this category in 1996. One

participant is described as excellent of pushups in 1996. Of the 13 female participants

who performed the push-up test, one femde reduced her push-up total to drop one

descriptive category and five participants improved to increase their descriptive category.

Table 15 outlines the results of a repeated measures ANOVA for the variable of

maximum number of pushups. Non-sigrilficant differences were found for the main effects

of gender and time.

Table 15 Repeated Measures ANOVA and Descriptive Results for Pushu~s

EFFECT d f MS F P

BETWEEN SUBJECTS

Gender 1 0.136 0.00 1 0.970 Error 28 94.584

Time 1 27.225 0.620 0.438 TimexGender 1 13.225 0.30 1 0.588 Error 28 43.945

DESCRIPTIVE RESULTS YEAR

Females 11.7 11.4 31.3 Males 13.9 7.8 27.1

Table 16 highiights effect sizes for the number of pushups performed. Although

males from both the population and sample are reported to have srnall effect sizes, the

sample of males are shown to have a smaller effect of aging on pushups performance

compared to the general population. The population and sample of females had smail

effect sizes. Note, however, that the women's performances improved 1996, as reflected l

by the positive effect size value of 0.8.

Table 16 Cornparison of Effect Sizes for P u s h u ~ s

Population ES Sample ES GROUP Male -.40 -.28

Female -.15 .OS

4.3.3 Situps

Table 17 contains the group results for the number of situps performed in 60

seconds. In general, the percentiles for 1983 and 1996 for both males and females would

descnbe the participants as having poor performance (CSTF, 1981). Eight male partici-

pants were unable to perform a single sit-up within the 60-second time limit in 1996. In

1983, five male participants were unable to perfom a single situp. In 1983, 13 maie

participants were descnbed as "Poor", four as "Below Minimum", one as "Minimum", and

one as having "Good" performance. In 1996, 12 male participants are described as having

"Poor" performance, five as "Below Minimum", and one as "Minimum". Of the 18 males,

five decreased enough to lower their categorical description. Four moved to a more

favourable description. Six femaie participants in 1996 and one in 1983 were unable to

perform a single situp. In 1983, eight women were descnbed as having "Poor" fitness,

three as "Below Minimum", and three as "Minimum". In 1996, six were described as t

"Poor, six as "Below Minimum", and two as "Minimum" number of situps. With regard to

descriptive category, three females decreased and five increased. Situps, as a measure of

muscular endurance, appears to be an area of weakness for the persons in this study.

Table 16 depicts the results for the muscular endurance of the variable situps.

Pariicipants showed a significant decline in the number of situps performed.

Table 18 depicts the results of effect size calculation to measure the magnitude of

change in performance for situps. The results indicate that the males were fairly represen-

tative of the change found within the population. Both the sarnple and the population of

males had medium effect sizes. The females in this study had a medium effect size of 69

compared with the population's effect size of .23 which may be considered small. These

data for femaies indicate a greater change than would be expected.

Table 17 Repeated Measures ANOVA and Descriptive Results for Situps

EFFECT d f MS F P

BETWEEN SUBJECTS

Gender 1 47.580 0.352 0.558 Error 30 135.362

WITHIN SUBJECTS

Time 1 277.620 6.525 0.016 TimexGender 1 5.433 O. 128 0.723 Error 30 42.544

DESCRIPTIVE: RESULTS YEAR

Fernales 10.6 7.6 6.6 Males 11.7 12.8 9.5

Table 18 Cornparison of Effect Sizes for Sit-ups

Population ES Sample ES

GROUP Male 0.56 -.53

Female 9.23 -A9

Flexibility was measured with the use of a forward trunk flexion sit and reach test

(Govenunent of Canada, 198 1). An examination of the mean values for this test show I

that the participants performed better in 1996 than they did in 1983. In 1983, the males

had a mean flexibitity score of 22.9 cm. (percentilr 3 1.4) and a mean score of 23.3 cm.

(percentiie= 36.1) in 1996. The females had a mean score of 22.7 cm. bercentile= 19.4)

in 1983 and a rnean score of 26.2 cm. (percent&= 32.5) in 1996.

Two female participants scored very low in 1983 ( 4 . 2 ~ ~ 9cm) in cornparison to

the other participants. These two outlying scores had a large impact on the mean. When

these two scores are excluded fiom the calcuiation of the sample, the mean then becomes I

26.6 cm sirnilar to the mean in 1996. Although the participants displayed an

uncharacteristic in flexibility, the increase was found to be nonsignificant (p= 0.120).

Table 19 Re~eated Measures ANOVA for and Descri~tive Results for Fiexibilitv

- . - - - - -

EFFECT d f MS F P

BETWEEN SUBJECTS

Gender 1 5.455 0.043 0.837 Error 30 127.392

WITHIN SUBJECTS

Time 1 113.036 2.555 O. 120 TirnexGender 1 80.2 13 1.813 O. 188 Error 30 44.237

DESCRIPTIVE RESULTS YEAR

Males 22.9 9.5 31.5 23.3 10.0 34.1

Comparisons of the magnitude of change with the general population will not be

undertaken as the changes in fiexibiiity between the population and the sample are in

opposite directions (increases vs. decreases).

4.5 Cardiovascular Endurance (predicted VO,&

Table 20 contains the individual results for males and females for the Step Test.

One male participant was unable to complete the step test in 1996 due to a weakness in

one leg. Two fernaie participants did not complete the step test in 1996. One refùsed to

continue d e r cornmencing and another was not able to foliow the stepping pattern after

30 minutes of instruction. Scores for VO,, were available fiom 1983 for al1 partici-

pants.

Al1 participants who completed the step test demonstrated the correct stepping

pattern. However, most were unable to maintain the correct tempo correspondhg to their

level. This pattern is consistent with previous studies which reported problems with

maintaining a stepping cadence especially at the faster cadences (Cressler, et al., 1988;

Reid, et al., 1985; Seidl, 1986). Participants were able to increase their stepping rates

from stages one to three, however the stepping rate (ie. 14 ascentshin) was generaily

inconsistent through each stage. For participants who were unable to maintain the

predeterrnined tempo, actual rather than desired stepping rates during the final three

minutes were used to calculate the oxygen requirements (litredrnin). The oxygen require-

ments were interpolated fkom the values reported by Jette et al. (1976). It is important to

note that when using actual rather than predicted energy values, Jette et al. (1976)

reported a mean over prediction of 3.9% for the first four stages and a mean under - prediction of 4.2% for the last two stages for a female of 60 kilogram. I

The mean percentiles in both 1 983 (7.6) and 1983 ( 1 7.0) for males imply that their

level of cardiovascuiar fitness is described as "Poor". This description also holds true holds

true for females (1 983= 16.0; 1 996= 20.1). The individual data for 1983 show that nine

Table 20 Cardiovascular Endurance ï n d ~ d u a l Results(Predicted V02mar)

Subject Year V02 %ile Subject Year V 0 2 %iie Age Age

1

Average", two as "Minimumn, and one as "Good" . With respect to descriptive category,

seven males increased and one decreased.

The individual data for fernales in 1 983, reveals that four were described as having

"Poor" cardiovascular fitness, three as "Below Minimum", and five as "Muiùrum". in

1996, five fernales are described as having "Poor" levels of cardiovascular fitness, four as

"Below minimum", one as "Minimum", one as "Good", and one as having "Exceiient" per- a

forniance on the aep test. Of the 12 fernales who completed the step test in both 1983

and 1 996, four decreased and six increased their ranking description acwrding to their age

grou P.

Table 2 1 outlines the results of the repeated measues ANOVA X sigmficant

main effea of gender indicates that fernales had sigdicantly lower level of cardiovascular

fitness than males in both 1983 and 1996. in addition, subjects decreased in VO-

signiticantly Born 1983 to 1996.

Table 21 Reoeated Measures ANOVA and Descriptive Results for VOtmax (~redicted)

ANOVA EFFECI' d f MS F P BETWEEN SUWECTS

Gender 1 642.840 28.4 15 0.000 Error 28 22.623

TIME 1 TimexGender 1 Error 11

Table 21 (continuedl

Males 36.2 4.3 7.6 33.7 3.8 17.0

Table 22 indicates that the males had a medium effea sue in cornparison to the

large effect size seen in the population. The femdes were reporteci to have a much larger

effect size (large) than the population (medium). Interestingly, the males had a medium

effect size compared to the population's large effea size. This data ùidicates that females

in this study have very large changes in cardiovascular endurance when compared to males

and the expected population changes.

Table 22 Com~arison of Effect Sues for V02max Ipredicted)

Population ES Sample ES

GROUP - .- - - - - - -- -

Male -.87 -.60

Female 0.67 -1.02

Chapter 5

Discussion

The purpose of this study was to describe the physical fitness of perçons with an

intellectual disability and how their fitness has changed over time. This chapter will

include discussion of the results outlined in Chapter four as they relate to the stated

hypotheses and literature. Chapter five is organized in the following manner: (5.1)

Anthropornetric Measures; (5 -2) Muscular Endurance; (5.3) Flexibility; (5 -4)

Cardiovascular Endurance; (5.5) Change in Physical Fitness-Hypothesis 3.3.1 ; (5.6)

Magnitude of Change in Physical Fitness as Cornpared to the Population.

5.1.1 Height

The height of both males and females in this study is descnbed as "Below Aver-

age" when compared with adults of a similar age group. This finding is similar to one

other study (Reid et al., 1985). The individual data indicate that for the majority of

height decreased over tirne. This foiiows the trend in the data collected for

the Canada Fitness Survey (Govemment of Canada, 198 l), yet, small effect sizes were

found for both males and fernales for change in height between 1983 and 1996.

Males typically show a height increase until25-29 years and gradually decrease

thereafier (Spirduso, 1995). Fernales usually begin losing height as early as 16 years of

age. In general, femaies iose height more quickly than males due to a higher prevaience of

osteoporosis, especiaily after menopause. However, in this study, femaies appear to have

lost height at the same rate as males, as evidenced by similar effect sizes (see Table 5).

5.1.2 Weight

Participants had a significant increase in weight between 1983 and 1996. This is

consistent with Bndings for persons without disabilities which report steady increases in

weight untii 50 years of age (Spirduso, 1995). M e r age 50, weight begins to level off and

then decrease slightly during old age (Government of Canada, 198 1). The Ievelling off

and decrease in weight afler age 50 is apparent in this study. An exarnination of the

individual data show that in 1996,4 of the 5 participants over age 50 had a decrease in

weight from 1983.

In 1983, both males and females were descnbed as having "Below Average"

weight when compared to non-handicapped (Govemment of Canada, 1986). However,

males and females increased their weight by 1996 to the extent where they were con-

sidered "Average". The data for weight must be interpreted with caution as "Below

Average" or "Average" weight for persons who are shorter in stature may in fact be

classified as "Ovenveight" in relation to height.

Weight increase cm result from a number of factors such as an increase in muscle

m a s or increases in body adiposity. Again, in order to make rneaningful interpretations,

changes in weight must be looked at in conjunction with Body Mass index @MI) and

Percent Body Fat.

5.1.3 Body Mass Index (BMI)

BMI is a way of expressing weight in relation to the height of the person (Govem-

ment of Canada, 1996; Spirduso, 1995). BMI scores should be taken into consideration

dong with skinfolds measurements to account for distribution of body fat. As mentioned

earlier, increase in BMI may be proportional to increase in muscle mass or body fat.

Given the information which descnbes persons with an intel1ectual disability as having

below average height, an exarnination of BMI gives a relative measure of the participant's

weight in proportion to height.

BMI was described as "Average" compared to persons without disabilities for both

males and females (Government of Canada, 198 1). The femaies, however, moved to a

less favourable description in 1996 (below average). The substantial increase in BMI for

females is indicative of an increase in body fat and is consistent with findings that women

increase in BMI for 25 years d e r mens' BMI has stabilized (Spirduso, 1995). This may

be attnbuted to women having a substantial loss of muscle coupled with an increase in fat,

compared to men who generally having only a loss of muscle mass (Spirduso, 1995).

Increase in body fat content may be iinked to cenain common chronic diseases

(Raurarnrna et al., 1994). Effect sizes for both males and females show a greater magni-

tude of change in BMI than expected in the population and may indicate that persons with

an intellectual disability are at a certain hedth risk for coronary heart disease and Type II

diabetes (Shephard, 1990).

5.1.4 Percent Body Fat

Fox and Rotaton (1982) have show that there exists a prevalence of obesity for

persons with an intellectual disability. In this study, results fiom the three levels of

analysis (individual, group, and comparative) for percent body fat CO- that potential

health risks rnentioned in the previous section may exist. The increase in weight and BMI

fiom 1983 to 1996 are explained by an increase in percent body fat. Of dl the variables

measured, percent body fat appears to have resulted in the greatest magnitude of change

for both males and females. Although some increase in body fat is typicd of an aging

population, the participants in this study displayed a substantially greater magnitude of

change than the population, as evidenced by large effect sizes. Lifestyles which are seden-

tary may serve as a possible explanation for the high prevalence of obesity within this

sample (Fox & Rotatori, 1982; Montgomery et al., 1987; Femhall, 1990). This is discon-

certing as this sample, especially the femaies, who had already high levels of body fat in

1983, appear to be accumulating fat at an alarming rate. The health rïsks associated with

high levels of body fat (ie: cardiovascular disease, Type II diabetes) should be of major

concem for this sample (Blair, 1995; Pitetti et al., 1993; Raurarnrna et al., 1994, Rirnmer

et al., 1994).

5.2 Muscular Endurance

The literature suggests that age related changes are more subtle and gradua1 for

muscular endurance as compared to changes in other physical fitness performance

variables (Govemment of Canada, 198 1). Results in this study showed that changes in

performance were markedly greater for situps than pushups. This is consistent with the

findings of Reid et al. (1985). The test of situps measures the muscular endurance of the

muscles around the tmnk area while pushups measure the muscular endurance of the

upper arm and shoulder muscles. Disuse can erode the strength and endurance of certain

muscle groups (Spirduso, 1995). A greater deciine in strength and endurance occurs in

muscles used infrequently. Most of the participants work in assembly lines where they sit

for the majority of the day. During the work day they have little opportunity to use the

muscles in the tmnk area. Perhaps the muscles of the trunk area for this sample have been

used less fiequently than the muscles in the upper body, explaining the dEerences in

performance between sit-ups and push-ups.

The effect size (-.69) describing the change in muscular endurance for sit-ups, I

appears to indicate that the females are losing muscular endurance of a greater magnitude

than males (ES=-S3) when compared with the population. However, females performed

better in pushups in 1996 than in 1983. In fact, males had a smaii magnitude of change

(--28) compared to the moderate effect size for the population (-.40). It appears that age-

related change in rnuscular endurance is dependent upon the modality of exercise used and

muscle groups being tested. No known data have been found to explain differences in

muscular endurance as it relates to aging for dserent muscle groups. A need for informa-

tion in this area has been noted by Pitetti et al. (1993).

5.3 Flexibility

Flexibility is the degree to which an individual can move the joints through a range

of motion (Canada Fitness Survey, 198 1). Flexibility has been cited as difficult to measure

because performance is partly dependent on how much pain one is willing to endure :

(Spirduso, 1995). This measure rnay be even more difficult for persons with an intellec-

tua1 disability, as they have diaculty expressing discornfort when experiencing pain.

Compared to the 1983 performance, participants improved their performance on

the sit and reach test of flexibility, yet the repeated measures ANOVA showed that the

increase was not significant. in order to determine whether the results were due to

expenmenter error ten participants were retested producing an ka-class correlation of

0.92. Interestingly, the males, maintaîned the description of having "Below Average" I

flexibility in 1983 and 1996. Femaies, on the other hand, changed fiom a description of

"Below Average" in 1983 to "Average" in 1996.

5.4 Cardiovascular Endurance

Cardiovascular Endurance is defined as the ability of the heart and Iungs to deliver

oxygen to the muscles which in turn use the oxygen to perform work (Govemment of

Canada, 1986). The Canadian Home Fitness Test (CHFT) provides an estimation of

VO,, based on subrnaximal performance. The test is considered to be representative of

cardiovascular fitness (Governrnent of Canada, 198 1).

The descriptive results fiom both 1983 and 1996 indicate that the individuals in

this study have infenor cardiovascular fitness when compared with persons without a

disability. Other studies support these findings (e.g., Reid et al.. 1985, Pitetti & Tan,

1991; Rirnmer et al., 1993). Cardiovascular efficiency is related to muscle mass

(Shephard, 198%). Males have more muscle m a s than females and thus have the

capacity to use the oxygen needed dui-ing aerobic endurance activities. In terrns of aging,

muscle mass also has a direct effect on cardiovascular performance. Femdes Iose a higher

percentage of muscle mass than males as they age (Spirduso, 1995) which may partidly

explain the lower performance of females than males on tests of cardiovascular endurance.

Regardless of the level of training, cross-sectional data demonstrates that VO,,

decreases with age (Governrnent of Canada, 1982). Physicai activity patterns in persons

with an intellectual disability suggest that these persons are significantly Iess active than

persons without disabilities (Hoge & Dattilo, 1995). A sedentary lifestyle results in a

iower level of cardiovascular fitness. The significant change in VO- for both men and

women with inteiîectual disabilities suggests that age related loss in performance rnay be

partly due to a sedentary lifestyle. The participants showed low levels of cardiovascular

endurance, especially the females. In addition, females had a very large magnitude of

change in predicted VO- (ES=- 1.02) as compared to the population (ES=.67). Since a

minimum V02 of 13 mI.kg-'.min-' is considered necessary for independent living

(Shephard, 1987a), the sample of fernales appear to be in danger of succumbing to the

health risks associated with low levels of cardiovascuhr fitness. Thus, if this decline in

VO- continues, the fernales would be in danger of having disabiing levels of fitness at an

earlier age than expected, preventing them fi-om living independently.

5.5 Change in PhysicaJ Fitness-Hypothesis 1.3.1

The results of the repeated measures ANOVAs indicate that there is a sigiilncant

decrease in fitness for persons with an intellectual disability in al1 areas with the exception

of ffexibility, muscular strength and the muscular endurance test of push-ups. While there

is a tendency for females to show a greater change in physical fitness than the males for

most variables, these changes were not signifïcant. Information on persons without

disabilities also support these findings (Shephard, 1987a; Spirduso, 1995). With an

already documented sedentary lifestyle, minimal knowledge about the debiiitating effects

of poor physical fitness and health and an inability to take cornmand of their persona1 state

of health (Piteni et al, 1993), the persons in this study are falling even further into levels

of fitness which may place them at nsk for disease and a loss of independence. Percent

body fat and cardiovascular fitness appear to be the two areas where the most dramatic

changes are seen. Hypothesis 1.3.1; that the participants will have significantly lower

levels of physical fitness in 1996 compared to 1983, can then be accepted for al1 compo-

nents with the exception of flexibility and muscular strength.

Although these findings do not focus on the main interest of this study, it is

nevertheless meaninfil fiom the point of view that persons with an intellectuai disability

already have low levels of fitness and continue to decrease in fitness with age. If this

decline in fitness continues, certain health nsks associated with lower limits of physical

capacity will be acquired at a younger age than expected in the general population. In

other words, this population will reach old age prier to chronological age expectations.

5.6 Magnitude of Change in Physicaî Fitness-Hypothesis 1.3.2

Hypothesis 1.3.2 stated that the magnitude of change in fitness for adults with a

disability will be greater than the magnitude of change in fitness expected in the general

population. The empirical data have already established that persons with an intellectual

disability have a lower level of physical fitness than persons without disabilities (Beasley,

1982; Coleman et al., 1976; Femhail, 1993; Pitetti et al., 1989; Reid et ai., 1985), and this

current study has replicated this fa&. Notwithstanding, the main interest in this sîudy was

to measure the change in physical fitness of persons with an intellectual disability in

cornparison to expectations of the general population. As mentioned earlier, Shephard

(1 987a) has suggested that lower limits of physical fitness can affect the capacity of

persons with and without a disability to perform basic functions of independent living.

The hypothesis sought to seek out information which suggests that persons with an

intellectual disability aiready have a lower level of physical fitness than persons without

disabilities and, more importantly, that their change in physical fitness is of a greater

magnitude than the general population.

The results nom the calculation of effect sizes indicate that the change in physicai

fitness for persons with an intellectual disability is of greater magnitude than expected in

the general population for the following variables: maximum oxygen uptake, height,

weight, BMI, percent body fat. and situps for females. Moreover, the data indicate that

females appear to be vulnerable to these changes, especially for the variables of percent

body fat and VO-.

Two anthropornetnc measures, BMI and percent body fat, showed signincant

differences of change between the sarnple and the population. For BMI the population

had small effect sizes compared to the moderate effect sizes of the population. The

sarnple had large eEect sizes for percent body fat compared to the small effect sizes

expected in the population. Both flexibility and grip strength were not compared to the

population as increase in performance of these variables was contrary to the decrease

observed in the population data. A significant increase in grip strength appears to be the

result of instrumentation error and, therefore, was not anaiysed at the level of cornparison

with the population. Further investigation into changes in activity patterns and testing

preparation for persons with an intelieauai disability seems warranted.

Muscular endurance was measured with pushups and situps. The effect sizes

indicated that a decline in performance in both population and sample groups was greater

for situps than push-ups. There were no marked dinerences in push-ups for both males

and females with an intellectual disability when cornpared to the population. However,

there were large daerences for women in the performance in situps between 1983 and

1996. The males effect sizes were very similar to the population (moderate). The results

indicate that situps, measuring the endurance of the muscles of the trunk area, appear to

have changed more notably than pushups, measuring the endurance of the muscles of the

arms and shoulders, especiaüy for females. Certain muscle groups deteriorate quicker

than others due to disuse rather than aging (Spirduso, 1995). As well, some evidence 8

suggests fat is distributed to a greater extent in the waist and hip area resulting in greater

losses of muscle mass (Shephard, 1987b). Thus, it is possible that a sedentary Mestyle

additionally contributed to the decline in muscular endurance nomally related to aging.

Like percent body fat, the change in predicted VO- of females between 1983

and 1996 was large (ES= -1 -02) cornpared to the moderate change expected for perçons

without disabilities (ES= -.67). These findings are very concerning, as cardiovascular

fitness has been identified as having a direct relationship to one's ability to perform tasks of

daily living and rnay be related to the prevention of disease (Jette et al., 1992). In contrast

the males had a moderate effect sue (-.60) than the large effect cornputer for the popula-

tion (-.87).

It is important to highlight the results of the individual data to shed light on the

enormous variability among the subjects. Although the general group trend for cardiovas-

cular endurance (and with other variables) is a decline in performance, the individual data i

shows that certain individuais had linle change or an improvement in performance between

1983 and 1996. This variability in performance has been previously diçcussed (Seidl et ai.,

1987) and has prornpted some to advocate aiternate methods of data anaiysis when

dealing with speciai populations (Bouffard, 1992; Watkinson and Wasson, 1984).

Although this research has s h o w a dennite group trend toward a decline in fitness, the

variability among the subjects must be scrutinized for contributhg factors such as;

fluctuations in motivation, dserences in lifestyle, dietary habits, etc. aflkting changes in

fitness with aging.

Generdizations about the magnitude of change in overaii fitness are difficult to

explain in light of the varying degrees of change between the variables measured used in

this study. To date no measure of total fitness is available within the CSTF (Govemment

of Canada, 1986). A generai conclusion c m be made that the hypothesis (1 -3.2) stating

that a greater magnitude of change wili occur in persons with an inteliectuai disability

when compared to the population, is accepted for the component of Cardiovascular

Endurance in females, Body Adiposity (weight, BMI, percent body fat) for both males and

females, Muscular Endurance as rneasured by situps for females. Hypothesis 1.3.2 is

rejected for the dependent measures of Flexibiiity, and Push-ups for both maies and

females, and CardiovascuIar Endurance for males.

Chapter 6

Summary, Condusions, and Recommendations

The purpose of this study was to describe the physicai fimess of persons with an

intellectuai disability and how fitness changeci over time. This chapter contains the

surnrnary and conclusions of this inquky and recommendations for fiiture research.

Chapter 6 is organized in the foiiowing manner: (6.1) Surnmary of the Methodology; (6.2) 1

Summary of the Findings; (6.3) Conclusions; (6.4) Implications; and (6.5) Recommenda-

tions for Fmher Inquiry.

6.1 Summary of the Methodology

Thrty-two adults with an inteiiectual disability participated. There were 18 males

and 14 f e d e s . Males had a mean chronological age of 40.9 years and ranged in age from

35 - 57. Fernales had a mean chronologicai age of 4 1.5 years and ranged in age fiom 34 - 5 1. Ail were detemiined to be k fiom physical and medical disabilities with the use of a

screening questionnaire. The participants were selected £iom a study in 1983. Their data

fiom 1983 was obtained for the purposes of cornparison to data collected in 1996. The

paicipants were describeci as moderately to miidly intellectually disabled and ail worked

in supporteci employment at a readaptation center. Lnformed consent was obtained from

the participants and their legal guardians and approval to condun the research was given

by the McGili University Ethics Cornmittee.

Data were collecteci using the procedures of the Canadian Standardized Test of

Fitness (Governrnent of Canada, 1 98 1, 1986). The dependant variables were

anthropometnc measurements of height, weight, BMI, and the sum of four skinfolds;

cardiovascular fitness as measufed by a aep test; flexibility as measured by a sit and reach

tes; musnilar endurance and ~ e n g t h as meanired by tests of sit-ups, pushups, and hand

grip strength.

Procedures from the CSTF (1 98 1) were used with ail variables except the step test

which foilowed the modifïed procedures outlined in Reid et al. (1985). In this test some

subjects were unable to maintain the recommended tempo, thus, actual, rather than

recommended stepping rates, were used to calculate the oxygen cost of stepping.

During a visit to their homes, participants were farniliarized with the testing

instruments and procedures prior to the teaing sessions. During the testing sessions

verbal encouragement and praise were given for aU attempts made. In addition, sorne

physicai prompting was given for participants that were initially unable to properly

perform the tasks. Most participants, with the exception of two, were able to complete ail

of the testing items. Two female subjects did not complete the step test. One was unable

to leam the correct stepping cadence and the other stopped stepping after one completed

stage. In addition, one of these females was unable to learn the correct technique for the a

push-ups.

The data fiom 1983 and 1996 were used to compare changes in physical fitness

over time. In order to test hypotheses, a three level approach was used to analyse the

data. First, individual data were analyzed to describe the performance of individuals and

groups based on descriptive noms from the CSTF (Govemment of Canada, 198 1, 1996).

Second, simple repeated rneasures analyses were performed on each dependant measure to

illustrate the change in physicai fitness from 1983 to 1996. Third, in order to determine

the magnitude of change in fitness over time as cornpared to the population, effect sizes

for both the population and the sample was cdculated and compared. Due to small

sarnple sizes, the effect sizes were corrected using the methods of Hedges (198 1).

6.2 Summary of the Findings

Results from this study confirmed previous research which demonstrated that

persons with an intellectual disabiliîy have lower levels of fitness when compared with

noms established for persons without disabilities. Generaüy, fernales had lower scores on

most fitness measures than males. A repeated measures analysis of variance on each

dependant measure demonstrated significant ditferences for the variables of cardiovascular

fitness, weight, BMI, percent body fat, and muscular endurance. In addition individual

analysis indicated that there was high variability in performance among the participants.

While some showed a decrease in performance between 1983 and 1996, others showed

little change or improvement.

Effect sizes were used to determine the magnitude of change between fitness

measured in 1983 and 1996. These effect sizes were compared to the calculated effect

sizes for the population as represented by data taken the Canada Fitness Survey (198 1).

Larger effect sizes (c.70) were found for females than the population in muscular

endurance as measured by sit-ups and cardiovascular fitness. Both males and femaies had

greater changes in body composition (weight, BMI, and percent body fat). Persons with

an inteiiectual disability had a greater change of physicai fitness with age, as previously

mentioned there waj high subject variabiiity in performance within and between each

component of fitness. It is also important to note that 25% of the potential sample was

screened out of the testing due to some form of an acquired disability. This percentage is

rather high and rnay indicate a tendency of this population to acquire functional losses of a

greater frequency that the general population.

6.3 Conclusions

Based on the findings of this study and within the limitations previously outlined,

the following conclusions may be made:

1. Adults with an intellectual disability have below average scores on most

components of physical fitness when compared to Canadian adults without a disability of

comparable age and gender.

2. Femaies with an inteiiectual disability have poorer levels of physicai fitness than

males with an intellectual disability.

3. Adults with an intellectual disability have significant changes in physical fitness

as t hey age.

4. Adults with an intellectuai disability generally have a greater magnitude of

change in physical fitness as they age when compared to Canadian adults without a

disability of comparable gender and age.

6.4 Implications

It has been previously demonstrated that adults with an inteliectual disability

exhibit substandard physical fitness when compared to adults without disabilities. The

findings of this study reinforce these previous data. It has also been shown that in the

population of non-disabled adults, poor levels of fitness may increase the nsk of some

cornrnon ctironic diseases such as diabetes mellitus, and cardiovascular disease. In terms

of physical fitness characteristics, evidence exists indicating that persons with an intellec-

tua1 disability have an earlier onset of old age presumably due to sedentary living habits

which result in low levels of physicai fitness (Pitetti and Campbell, 1991). There also

appears to be a tendency in this population to acquire an early onset of cardiovascular

disease. No data exists explaining the causes of early onset conditions which affect

health. Further to this, no known data exist which trace the effects of aging of physical

fitness and heaith for persons with an intellectual disabiiity.

The major contribution of the study is it has demonstrated that, when compared to

the general population, the magnitude of change in physical fitness is generally larger for

adults with an intellectual disability. The tendency is to fa11 deeper into already lower

levels of physical fitness as aging occurs. Although these findings are preliminary in

nature and subject to certain limitations, it does imply that the physical fitness of persons

with an intellectual disability declines at a faster rate than persons without a disability.

More importantly, the results indicate that the percentage of body fat and cardiovascular

fitness of the participants were shown to have the greatest magnitude of change when

compared to other components of fitness, especiaüy for fernales. Poor cardiovascular

fitness and excess body fat are seen as major indicators for cardiovascular diseases.

The findings support the srnail amount of research illustrating an early onset

cardiovascular disease and old age in persons with an intellectual disability. In light of

these findings, health professionais and care-givers should recognize the specüic and

urgent physical fitness needs for these people. Appropriate measures need to be taken to

find ways of increasing the physical activity patterns of a characteristically sedentary

population. The findings of this study also have implications for additional interactive

factors influencing the health of persons with an intellectual disability. Poor levels of

fitness may lead to poor health, potentially placing a public burden on the health Gare of

these people. Escalating heaith care cost s and societal responsibility for an increasing

population of adults with an intellectual disability are areas of concem. Additionally, diet I

and nutritional habits must be examined for any interactive effects on fitness and health.

Given the findings of this investigation, the duration, intensity and frequency of

participation in physical activity is of interest for those investigating dose-response issues.

With some evidence suggesting that moderate amounts of physicai activity can improve

health, the implications for persons with an intellectual disabiiity are encouraging. Perhaps,

the Active Living rnovement may be a feasible means of encouraging people to provide

accessible programs which will encompass the physical, nutritional, and social needs of

this population.

6.5 Recommendations for Further Investigation

1. Research which describes physical fitness has lacked the comprehensiveness of l

measurement of Reid et al. (1985). In order to explain the relationship between specific

components of fitness and their influence on fùnctional capacity and health, more descrip-

tive research is needed which looks at al1 components of physical fitness.

2. Information about the effects of aging and physical activity on the physical

fitness of persons with an intellectual disability is lacking. Longitudinal studies with

inclusion of lifestyle questionnaires are needed to determine the relationship between aging

and effects on physical activity, fitness, and health.

3. Research is needed to determine the causes and interactions of factors which

contribute to low levels of fitness. 1s a sedentary Mestyle the cause of low fitness or Iow

fitness the cause of a sedentary lifestyle?

4. Considering the low levels of physical fitness, it appears that persons with an

intellectuai disability are at a higher risk for disease than those without disabilities. More

research is needed to d e t e d e a clear relationship between the early onset of disease

and/or disabling conditions and poor physicai fitness.

5. Further investigation into developing valid and reliable measures of physical

activity for persons with an intellectual disability is needed. Moreover, in order to obtain

accurate measures of physical fitness, researchers must develop standardized protocols I

and techniques which take into consideration the problems of motivation and variable

performance of persons with an intellectual disability.

6. The variability in performance in persons with an intellectud disability is

apparent. Future research should employ the use of individual anaiysis dong with

traditional group analyses to provide detailed information about the variabiliîy in perfor-

mance often seen in this population.

7. Since, until now, no research has been available describing the changes in

physical fitness of persons with an intellechial disability as they age, repiications should be

conducted to discover the generaiizability of the hdings obtained in this study.

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APPENDIX A

ANTHROPOMETRIC PROCEDURES

HEIGHT

(Equipment and procedures)

Equipment: Metric Wall tape, set square

Procedure: Position the tape vertically against a wall. Ensure that the tape is perfectly straight and even with the floor. The participant will be without footwear. The participant's back is placed against the wall tape with the heels together and the body stretched upward to its Wes t extent, the shoulders relaxed and the arms placed at the side. The set square is rested on top of the head, making contact with the skull and against the tape. Height will be recorded to the nearest 0.5 cm from the highest point on top of the head.

- p-

Note: From the Canadian Standardized test of Fitness Ooerations Manual, 2nd. ed., p.7, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

WEIGHT (Equipment and procedures)

Equipment: Spring or bearn scale

Procedure: The participant will be without footwear and in light clothing (shorts and t-shirt or blouse for women). Ensure the scale is placed on a flat surface. Weight will be recorded to the nearest 0.05kg.

Note: From the Canadian Standardized test of Fitness O~erations Manual, 2nd. ed., p.7, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

SMINFOLDS (Equipment and procedures)

Equipment: Harpenden Caliper

General Procedures: The four skinfolds will be measured twice and recorded to the nearest 0.2 mm. If the measurement difEers by greater than 1 .O mm, a third measurement wiIi be taken and the mean of the closest pair recorded. Select the prescnbed site. Grasp the skinfolds between the thumb and index finger 1 cm. above the site and apply pressure. The skin fold is raised and maintained with the thumb and forefinger with the crest of the fold foilowing the specific alignment. Apply the caliper jaws at right angles to the prescnbed site. Release the spring handles fuUy. Read the measurements after the fùil pressure of the caiiper jaws has been appiied, and the drift of the neede has ceased. The four skinfolds are measured on unclothed sites on the right side of the body.

f l - precise identification of the site of the skidolds. - forminp the skinfolds vnor to the apolication of the cali~er iaws. - the standardkation of the a l i m e n t of the skinfolds crest. - complete release of the s~rinn handles of the cali~er.

Triceps skinfolds: The participant stands with the m s relaxed at the sides. The skinfolds is measured on the unclothed right arm at a level rnidway between the tip of the acrornium (top of shoulder) and the tip of the elbow. With the participant's forearm flexed at a 90' ande, establish the rnidpoint. This cm be approximated with the thumbs by placing the fifth finger of the lefi hand on the participant's right shoulder and the fifth finger of the right hand on the tip of the participant's elbow. Lift the skinfolds paraiiel to the long axis of the a m . Ask the participant to lower the forearm and then apply the caiiper jaws to the site.

Biceps skinfolds: Measured on the front nght upper arm over the biceps at a level midway between the acromium and the tip of the elbow as described for the triceps. The skinfolds is lifled paraliel to the long axis of the upper am.

Su bscapular skinfolds: The participant stands with arms relaxed at the sides. The subscapular skinfolds is measured about 1 cm below the Iower right angle of the right scapula. The crease of the skinfolds that is lifted should run at an angle of about 45" downwards fiom the spine.

Supra-üiac skinfolds: a

The participant stands with the right am slightly bent and at the side so that there is access to the skinfolds sight. Measured 3 cm above the iliac crest at the midline of the body, with the fold running paraIIel to the iliac crest.

Note: From the Canadian Standardued test of Fitness Ooerations Manual, 2nd. ed., p.10-11, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

APPENDIX B

STRENGTH PROCEDURES

HAND GRIP STRENGTEI (EQUIPMENT AND PROCEDZTRES)

Equiprnent: Stoelting hang grip dynarnometer.

Procedrrre: Have the participant take the dynarnometer in the appropriate hand, holding it down by the thigh. The grip is taken between the fingers and the palm at the base of the thumb. With a tinn g i p , hold the instrument away fiom the body and squeeze Mgorously, exerting maximum force. Neither the hand nor the dynamometer are allowed to touch the body. both hands are rneasured altemately giving two trials per hand. The best score for each hand wiil be added and recorded as a single score to the nearest kilogram.

-- - -

Note: From the Canadian Standardized test of Fitness O~errtions Manual. 2nd. ed., p.16, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

APPENDJX C

MUSCULAR ENDURANCE PROCEDUWS

PUSH-UPS (Equipment and procedures)

Equipment: Gym mat

Procedure: Two levels of push-ups wiil be accepted with the participants.

Level 1: The participant starts in the prone position (lying on stomach) with legs together and the hands pointing forward and positioned under the shoulders. Using the toes as a pivotal point, the participant wiii push fiom the mat, straighten the elbows and reach the up position. The upper body must be kept in a straight line as the participant retums to the starting position touching the chin to the mat. The push ups will be A

perfom consecutively without a time b i t . The test will be discontinued irnmediately upon seeing the participant show signs of strain. The number of successful push-ups completed will be recorded as the test of upper body muscular endurance.

Level 2: The participant starts irt the prone position with legs together. The hands are pointed forward placed directly under the shoulders. The participant pushes up fiom the mat with the hands, straightening the elbows and using the knees as a pivotal point. The upper body will be kept in a straight line as the participant retums to the starting position with the chin touching the mat. Push-ups will be performed consecutively and the test discontinued as soon as the participant begins to show strain. The number of successfùl push-ups completed will be recorded as the test of upper body muscular endurance.

SIT-UPS (Equipment and Procedures)

Eqiiipme~ir : Gyrn Mat, timer or stop-watch.

Procedzire: The participant will begin in the supine position (lying on the back) with the knees bent approximately 90 degrees and the feet about 30 cm apart. The hands will be placed at the side of the head, fingers touching the e m . The tester will hold the ankies of the participant ensuring the heels are in constant contact with the mat. #en the participant is ready give the cornmand "Begin". The participant is required to sit up and touch the knees with he elbows and r e m to the starting position. The tester will ensure that the participant's back retums to the original position and that the participant attempts to exhale when sitting up and inhale when retuming to the starting

position. The participant may pause whenever necessary. The participant WU perform as many sit ups as possible in one minute.

Note: From the Canadian Standardized test of Fitnus Oaerations Manual. 2nd. ed., p.17, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

APPENDIX D

FLEXIBILITY PROCEDURES

S ï ï AND REACH TEST (Equipment and Procedures)

Eqdprne~~t: Modified Wells and Dillon sit and reach apparatus.

Procedure: Before taking actual measurements, have the participant warm-up by perfonning slow stretchg movements . The barefoot participant sits with legs M y extended with the soles of the feet placed flat against the horizontal crossbar of the apparatus and the h e r edge of the sole placed 2 cm f?om the scale. Keeping the knees fuiiy extended and the amis eveniy stretched, palms down, the participant bends and reaches forward without jerking) pushing the siidhg marker forward dong the scale as far as possible.

1

The position of maximum flexion must be held for approximately two seconds. At maximum flexion, encourage the participant to lower the head to obtain maximum reach. The knees must remain straight in order for the trial to be counted. Two trials wiü be permitted. Jerking movements will not be permitted. The maximum distance of the two trials wiU be recorded to the nearest 0.50 cm.

Note: From the Canadian Standardized test of Fitness O~erations Manuai, 2nd. ed., p.17, by Fitness and Amateur Sport Canada, 1981, Ottawa, Ontario, Canada: Author: Copyright 1981 by Minister of Supplies and Services.

APPENDIX E

HEART RATE AND BLOOD PRESSURE PROCEDURES

(Equipment and procedures)

Equlpment: "SUNBEAM" Digital Blood Pressure and Heart Rate Monitor (Mode1 7650)

Procedure: Have the participant rest for five minutes. Use a chair with comfortable arm rests. During this tirne the Canada Home Fitness Test will be explaineci and demonstrated. Apply the blood pressure cuff to the participant's Ieft arm. The cuff should be wrapped f m i y and smoothly 2-3 cm above the antecubital space. The arm should be comfortable with the lower edge of the cuff at heart level and at an angle of 0-45 degrees fiom the tnink. Press the "start" switch and the cufF wili autornaticaiiy inflate. When the pressure in the cuff has reached the pressure valve setting, the automatic exhaust mechanism will graduaiiy reduce ann cufF pressure. NOTE: Accurate measurement carinot be taken when exhaust speed is outside the 2-5 mmHg range. when a pulse is detected, a beeping sound will begin indicating the heart rate is being taken dong with the blood pressure reading. When the buzzer sounds this indicates that the measurements have been completed. Systolic pressure is displayed on the right, and diastolic is displayed on the lefi, 2 or 3 seconds later the pulse appears altemately on the display. If the resting heart rate is above 100 beatdminute, or the resting systolic blood pressure exceeds 150 mm Hg, or the resting diastolic blood pressure is over 100 mm Hg, wait an additional five minutes and take the readings again using the same procedure as above. The participant is excluded fkom the cardio- respiratory fitness test if the values are still above the criteria.

APPENDIX F

CARDIOVASCULAR ENDURANCE PROCEDURES

CANADA HOME FITNESS TEST (m (Equipmeot m d procedures)

Equipmer~t: Double 20.3 cm portable neps, tape player, CHFT tapes, timer.

Procedure: The participant steps up and down the two seps in synchronization with a tempo

delivered on a music tape. The stepping cadence for one ascent and descent of the box is d e s c r i i to the participant with the hdp of the foiiowing description fiom the prepared tape:

S m - S m - U P STEP - STEP - D O W U P - 2 - 3 D O W - 2 - 3 U P - 2 - 3 DOWN-2-3

J

The participant practïces the starting sequence, &st without the music and then with the music. Ensuring the participant places both feet completely on the second step and that the legs are completely extended and back upright at the top of the steps.

The starting stepping mercise is based on the age of the participant and can be found below

Sm

FEMALE

FEMALE

The stepping tempo will increase with each successive stage.

Each stage of the stepping exercise is three minutes in duration. When the three minutes are up, the participant is instructed to remain motionles A 10 second post-exercise heart rate is recordeci using the stethoscope. It is unnecessary to stop the tape between stages of the test since pauses for counting are recorded on the tape. The participant advances to the second

AGE

30-39

3049

MALE

MALE

30-39

40-49

4

3

STARTING EXERCISE SECOND STAGE

114

102

ASCEND /MM

17

14

LEVEL

3

L. 7

LEVEL

4

3

19

17

5

4

1

CADENCE

102

84

CADENCE

114

102

132

I l4

ASCEN DJMIN

19

17

22

19

and then third stage of the test if the heart rate is below a pre-established target value. The 10 second ceiling heart rates are:

The hart rate f?om the last stage completed in the test is used to predid maximum oxygen uptake. The regression equation (lette et al, 1976) used to predia maximum oxygen uptake is:

P

+ 16.6 VO, (lhin)

- o. 12 Weight (kg)

AGE

3 0-3 9

4049

50-59

- 0.12 Post Exercise Heart Rate (beats/min)

- 0.24 Age (yrs)

ARTER 1st STAGE

28

26

25

Previous research (Reid & Montgomery, 1983; Seidl, 1986) have s h o w that some persons with an inteliectual disability experience ciifEcu1t-y rnaintaining the tempos on tape. Therefore, counting the number of axents for each participant and calcdating the energy demand of the stepping usuig tbe dues reported by Jette et al (1 976) will be used as a means of obtaining a prediction of maximum oxygen uptake.

m R 2nd STAGE

25

24

23

NOTE: The test wül be dûcoatinued if the participant begins to stagger, cornplains of dizziness, extreme leg pain, oausea, chest pain, or shows faciai pdor . If any of these symptoms m u r have the participant lit down, check the heart rate and blood pressure. Request assistance from emergency medicd personnel (ie. 911) if the participant does not seem to recupernte after a few minutes.

APPENDIX G DATA COLLECTION FORMS

MCGILL UNIVERSITY - DEPARTMENT OF PHYSICAL EDUCATION DATA SHEET

Name Date Tester Date of Birth Age Gender

Weight (Ib.) (kg 0- 1 ) Refûsed Height (in.) (cm O. 1) Refused

SKINFOLDS (nearest 0.2) I I f f l

Triceps

Biceps

Subscapular

Supra-iliac

KAND GRIP STRENGTH (nearest 0.5 kg)

BLOOD PRESSURE AND RESTING HEART RATE (sitting for 5 min.) 1 I I I 11

Right

Left

Stren h ITo t a lg t H o n

Trial 1

Trial 1 -

Diastolic

*** Only do Trial 2 if participant exceeds the criteria for acceptance.

*** Trial 2

Triai 2 Trial 3 Mean

Rehsed Unable I

Refùse Unable

CANADA HOME FITNESS TEST (step test) Name Age- Refused

STARTTNG LEWL CEILING POST EXERCISE HR MEN WOMEN

Age Level Steps Level Steps &E M e r After Stane 1 Staae 2

50's 2(84) 14 l(66) 11 50's 25 23 40's 3(102) 17 2(84) 14 40's 26 24 30's 4(114) 19 3(102) 17 3 0's 28 25 20's S(132) 22 3(102) 17 20's 29 27 15-19 5(132) 22 4(114) 19 15-19 30 27

6(144) 24 S(132) 22 7(156) 26 6(144) 24

Starting Recornrneoded Time Actuai Rate Mean H.R Comments

3 minute Recovery Hearî Rate (in 15 seconds) (beatdrnin)

Refused Unable to obtain

PUSHUPS (number) Level 1 Refused Level2 Unable to obtain-

(reason) -

TRUNK FLEXION (nearest 0.5 cm)

Refiised Unable to obtain (reason)

SIT-UPS (max in 60 sec)

Level 1 (bands behind head) No.- Rehsed Level2 (amis above head) No.- Unable to obtain Level3 (holding assistant's hands) No.- (reason)

APPENDIX H

DESCRIPTION OF STUDY AND CONSENT FORRI

Dear Parent/Guardian or Caregiver,

1 am doing a Master's Thesis with the Department of Physical Education of McGill University under the supenision of Dr. Greg Reid 1 wouid ike to ask for your assistance and cooperation in cornpleting my research.

The purpose of this research is to examine the change in physicd fitness of a group of aciults with an intcllectual disobiiity who were tested 13 years ago. was part of this group tcsted by Dr. Greg Reid and his colleagues. By testing these individuals 13 years later, we hope to discover how thcir change in fitness compares to persons who are non-disabled.

The participation of the subjects wiii require them to be evalurited on "The Crinadian Stmdardized Test of Fitness". Testing time will be a maximum of 2 hours and wili take place at Options of the West Island Readap tation Center.

Six fitness tests will be used to evduate each individuais' overall fitness; (1) measurements of standmg height and weight; (2) body fat estimates fiom slanfolds measurememts; (3) strength measurement using a hand grip device; (4) muscdar endurance measurements using sit ups and push ups; (5) flexibiiity using a sit and reoch test and; (6) cardiovascuiar endurance measurement using a step kst. The procedures fiom the "Canadian Stand;irduRd Test of Fihiess wiil be used for di tests with Lhe exception of the step test.

The step test requires the penon to ascend and descend two steps at a pre-estûbiished tempo set by a music tape. However, many participants in the study conducteci 13 years ago experienced dificuity keeping a stcady pace with the music, Lherefore, the participants in the ciment study wiil be asked to step at their own desired pace.

The fitness tests used in tbis shidy are used by thousands of chiidren and adults every year in Canada. 2 would like to assure you thut the Jtness tests are not extremely srrenuous and that the safity and well-being ofthe participants will be gwen priority over their performance. nie testers will be fruined in the safeîy of udministering the testing items. As well, salery controls are built inro eoch tesr. It is very important to note thût adults with czirdiovascular disease or chronic physicd problems (ie, back, hee, etc) shouid not participate in this study. The participant may choose not to participate and may wihdraw fiom the teshg at anytune. Each participant will be screened for any medical problems by completiag a Physicd Ac tivi ty Readiness Ques tionnriire (Par-Q).

Written permission and a completed Par-Q questionnaire are needed to enable t O

participate in this study. Plcase fiil out and sign the permission f o m attiiched indicating whether - will or will not participate by April 1, 1996. If you have any questions or concems please cal1 me at 684-9845 or Dr. Reid at 398-4185.

Thank you for your cooperation,

Andrew Graham (B.Ed Phys.Ed.)

CONSENT FORM

check off one. sign the fom. and return ASAP.

1 have read and understood the idormation for Andrew Graham's study on physical

fitness. 1 give permission - or 1 wiil not give permission - for to participate in the study.

(nime of participant)

PARENT/GUARDIAN/CARE:GIVER SIGNATURE:

PARTICIPANT SIGNATURE: (if possible):

DATE:

APPENDIX 1

REVISED PEIYSICAL ACTIVITY READINESS QUESTIONNAIRE

PAR - W & YOU

! IT

you 'answered

I have read. undenfood and compieted fils puesthnaire. Any questions I had were answered to rny M satisfaction 1 Khw

S K I W m DATE I

APPENDIX J

M C G U ETHICS COMMITTXE APPROVAL

MCGILL UNIVERSITY FACULTY OF EDUCATION

- - d CERTIFICATE OF ETHICAL ACCEPTABILITY FOR RESEARCH

INVOLVING HUMAN RIGHTS - *

A review cornmittee consisting O C throo of the following members:

1) Prof. E. Lusthaus

2 ) Prof. R I Ghosh

L) Prof. M. Maguire

2 P r o f . N. Jackson

3 ) Prof. M. Downey 3 ) Prof. R. Turcotte

has examined the application for certification of the ethical acceptability of the project t i t l e d : I

t

' ~ h p i c a f F i t n e s s of Adults vith an Intellectual Disability: A 23 Year F o l l o w - up Studym

8

as proposed by:

App 1 ican ts name : Andrar Oraham

Supervisor's name: Dr. O r m g Ra

Applicants s ignature: 0 - Supervisor's signature:

G r a n t ing Agency :

Associate Dean

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